Provider Demographics
NPI:1174826622
Name:RODRIGUEZ, IDALMIS C (BA)
Entity Type:Individual
Prefix:
First Name:IDALMIS
Middle Name:C
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5600 SW 135TH AVE
Mailing Address - Street 2:STE 207
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33183-5101
Mailing Address - Country:US
Mailing Address - Phone:786-216-9484
Mailing Address - Fax:305-603-7955
Practice Address - Street 1:5600 SW 135TH AVE
Practice Address - Street 2:STE 207
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33183-5101
Practice Address - Country:US
Practice Address - Phone:786-216-9484
Practice Address - Fax:305-603-7955
Is Sole Proprietor?:No
Enumeration Date:2010-12-06
Last Update Date:2021-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker