Provider Demographics
NPI:1225568215
Name:RODRIGUEZ, ANA IBIS
Entity Type:Individual
Prefix:MRS
First Name:ANA
Middle Name:IBIS
Last Name: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 1:6095 W 18TH AVE APT S203
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-6128
Mailing Address - Country:US
Mailing Address - Phone:305-591-7898
Mailing Address - Fax:
Practice Address - Street 1:6095 W 18TH AVE APT S203
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-6128
Practice Address - Country:US
Practice Address - Phone:305-318-1403
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-13
Last Update Date:2020-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-20-123279106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician