Provider Demographics
NPI:1376179739
Name:MACHADO RODRIGUEZ, ROBERTO CARLOS
Entity Type:Individual
Prefix:
First Name:ROBERTO
Middle Name:CARLOS
Last Name:MACHADO RODRIGUEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27660 SW 135TH AVENUE RD
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33032-2568
Mailing Address - Country:US
Mailing Address - Phone:786-616-2611
Mailing Address - Fax:
Practice Address - Street 1:20230 SW 320TH ST
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33030-5103
Practice Address - Country:US
Practice Address - Phone:786-616-2611
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-18
Last Update Date:2023-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X
FL0-23-14861106E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician