Provider Demographics
NPI:1164162145
Name:RODRIGUEZ, ROBERTO IVAN I
Entity Type:Individual
Prefix:
First Name:ROBERTO
Middle Name:IVAN
Last Name:RODRIGUEZ
Suffix:I
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11965 SW 188TH TER
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33177-3256
Mailing Address - Country:US
Mailing Address - Phone:786-231-4729
Mailing Address - Fax:
Practice Address - Street 1:11965 SW 188TH TER
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33177-3256
Practice Address - Country:US
Practice Address - Phone:786-231-4729
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-29
Last Update Date:2022-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician