Provider Demographics
NPI:1275282865
Name:RODRIGUEZ RODRIGUEZ, MERCEDES C
Entity Type:Individual
Prefix:
First Name:MERCEDES
Middle Name:C
Last Name:RODRIGUEZ 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 1:10951 SW 154TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33157-1218
Mailing Address - Country:US
Mailing Address - Phone:786-222-1289
Mailing Address - Fax:
Practice Address - Street 1:10951 SW 154TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33157-1218
Practice Address - Country:US
Practice Address - Phone:786-222-1289
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-21
Last Update Date:2023-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-19-108806106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician