Provider Demographics
NPI:1225895063
Name:RODRIGUEZ NIETO, KAREN
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:
Last Name:RODRIGUEZ NIETO
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 1:7900 TATUM WATERWAY DR APT 412
Mailing Address - Street 2:
Mailing Address - City:MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33141-1938
Mailing Address - Country:US
Mailing Address - Phone:786-350-5930
Mailing Address - Fax:
Practice Address - Street 1:7900 TATUM WATERWAY DR APT 412
Practice Address - Street 2:
Practice Address - City:MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33141-1938
Practice Address - Country:US
Practice Address - Phone:786-350-5930
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-28
Last Update Date:2024-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-23-280474106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician