Provider Demographics
NPI:1326804972
Name:RODRIGUEZ, MARILANDA C (N/A)
Entity Type:Individual
Prefix:
First Name:MARILANDA
Middle Name:C
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:N/A
Other - Prefix:
Other - First Name:MARILANDA
Other - Middle Name:C
Other - Last Name:RODRIGUEZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:N/A
Mailing Address - Street 1:3640 S FULTON AVE UNIT 1139
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30354-1757
Mailing Address - Country:US
Mailing Address - Phone:484-663-1726
Mailing Address - Fax:
Practice Address - Street 1:3640 S FULTON AVE UNIT 1139
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30354-1757
Practice Address - Country:US
Practice Address - Phone:484-663-1726
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-22
Last Update Date:2024-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician