Provider Demographics
NPI:1164972543
Name:RODRIGUEZ DEL REY MARTINEZ, MEYLIN
Entity Type:Individual
Prefix:
First Name:MEYLIN
Middle Name:
Last Name:RODRIGUEZ DEL REY MARTINEZ
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 1:15610 SW 105 LANE
Mailing Address - Street 2:APT 610
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33196
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:14142 SW 93RD LN
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33186-1272
Practice Address - Country:US
Practice Address - Phone:786-389-9580
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-10
Last Update Date:2023-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X
1-21-50463103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician