Provider Demographics
NPI:1457096703
Name:RODRIGUEZ VELASQUEZ, KATY SOFIA
Entity Type:Individual
Prefix:
First Name:KATY
Middle Name:SOFIA
Last Name:RODRIGUEZ VELASQUEZ
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 1:20803 NW 3RD LN
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33029-2127
Mailing Address - Country:US
Mailing Address - Phone:786-458-6058
Mailing Address - Fax:
Practice Address - Street 1:20803 NW 3RD LN
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33029-2127
Practice Address - Country:US
Practice Address - Phone:786-458-6058
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-02
Last Update Date:2022-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician