Provider Demographics
NPI:1164167524
Name:VALDES RODRIGUEZ, ROSAURA
Entity Type:Individual
Prefix:
First Name:ROSAURA
Middle Name:
Last Name:VALDES RODRIGUEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:264 GREENBRIER DR
Mailing Address - Street 2:
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33461-1921
Mailing Address - Country:US
Mailing Address - Phone:561-699-4386
Mailing Address - Fax:
Practice Address - Street 1:1490 S MILITARY TRL STE 7
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33415-9141
Practice Address - Country:US
Practice Address - Phone:561-323-2552
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-30
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL22-211817106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician