Provider Demographics
NPI:1407027816
Name:RODRIGUEZ, ANTONIA M
Entity Type:Individual
Prefix:
First Name:ANTONIA
Middle Name:M
Last Name: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 1:680 NE 64TH ST
Mailing Address - Street 2:A 101
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33138-6208
Mailing Address - Country:US
Mailing Address - Phone:240-388-7387
Mailing Address - Fax:
Practice Address - Street 1:680 NE 64TH ST
Practice Address - Street 2:A 101
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33138-6208
Practice Address - Country:US
Practice Address - Phone:240-388-7387
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-13
Last Update Date:2008-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA9274235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist