Provider Demographics
NPI:1467943613
Name:RODRIGUEZ BOUZA, PENELOPE
Entity Type:Individual
Prefix:
First Name:PENELOPE
Middle Name:
Last Name:RODRIGUEZ BOUZA
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 1:12140 SW 200TH ST APT 1112
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33177-4977
Mailing Address - Country:US
Mailing Address - Phone:786-486-8879
Mailing Address - Fax:
Practice Address - Street 1:12140 SW 200TH ST APT 1112
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33177-4977
Practice Address - Country:US
Practice Address - Phone:786-486-8879
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-23
Last Update Date:2018-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician