Provider Demographics
NPI:1467732867
Name:RODRIGUEZ, DIANA YASMIN
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:YASMIN
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 1:2615 RIDGETOP WAY
Mailing Address - Street 2:
Mailing Address - City:VALRICO
Mailing Address - State:FL
Mailing Address - Zip Code:33594-4226
Mailing Address - Country:US
Mailing Address - Phone:305-890-3486
Mailing Address - Fax:
Practice Address - Street 1:2615 RIDGETOP WAY
Practice Address - Street 2:
Practice Address - City:VALRICO
Practice Address - State:FL
Practice Address - Zip Code:33594-4226
Practice Address - Country:US
Practice Address - Phone:305-890-3486
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-17
Last Update Date:2021-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst