Provider Demographics
NPI:1346794682
Name:RODRIGUEZ-PENA, ERICA
Entity Type:Individual
Prefix:
First Name:ERICA
Middle Name:
Last Name:RODRIGUEZ-PENA
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 1:1340 SE 7TH ST
Mailing Address - Street 2:
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34996-3213
Mailing Address - Country:US
Mailing Address - Phone:239-719-0561
Mailing Address - Fax:
Practice Address - Street 1:10685 SW STONY CREEK WAY
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34987-2741
Practice Address - Country:US
Practice Address - Phone:772-345-2700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-03
Last Update Date:2016-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOTA 13636224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant