Provider Demographics
NPI:1174033344
Name:RODRIGUEZ, ALBERTO JOSE
Entity Type:Individual
Prefix:
First Name:ALBERTO
Middle Name:JOSE
Last Name:RODRIGUEZ
Suffix:
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 1:11195 SW 1ST ST APT 220
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33174-1300
Mailing Address - Country:US
Mailing Address - Phone:786-571-9876
Mailing Address - Fax:
Practice Address - Street 1:11195 SW 1ST ST APT 220
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33174-1300
Practice Address - Country:US
Practice Address - Phone:786-571-9876
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-02
Last Update Date:2017-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty