Provider Demographics
NPI:1164206009
Name:RODRIGUEZ, VIVIANA
Entity Type:Individual
Prefix:MISS
First Name:VIVIANA
Middle Name:
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:VIVIANA
Other - Middle Name:
Other - Last Name:RODRIGUEZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MSC
Mailing Address - Street 1:260 SW 19TH RD
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33129-1425
Mailing Address - Country:US
Mailing Address - Phone:786-208-1598
Mailing Address - Fax:
Practice Address - Street 1:260 SW 19TH RD
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33129-1425
Practice Address - Country:US
Practice Address - Phone:786-208-1598
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-22
Last Update Date:2023-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Single Specialty