Provider Demographics
NPI:1366025322
Name:RODRIGUEZ GOMEZ, HEYDI (RN, BSN, RBT)
Entity Type:Individual
Prefix:
First Name:HEYDI
Middle Name:
Last Name:RODRIGUEZ GOMEZ
Suffix:
Gender:F
Credentials:RN, BSN, RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4350 CANAL 9 RD
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33406-7516
Mailing Address - Country:US
Mailing Address - Phone:786-370-0352
Mailing Address - Fax:
Practice Address - Street 1:4350 CANAL 9 RD
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33406-7516
Practice Address - Country:US
Practice Address - Phone:786-370-0352
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-28
Last Update Date:2022-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9598556163W00000X
FLRBT-21-155719106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLRN9598556OtherFLORIDA DEPARTMENT OF HEALTH
FL110150000Medicaid
FLRBT-21-155719Medicaid