Provider Demographics
NPI:1508342379
Name:RODRIGUEZ, CARIDEL (OCCUPATIONAL THERAPY)
Entity Type:Individual
Prefix:MS
First Name:CARIDEL
Middle Name:
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:OCCUPATIONAL THERAPY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1085 W 71ST ST APT 26
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33014-4603
Mailing Address - Country:US
Mailing Address - Phone:305-316-5956
Mailing Address - Fax:
Practice Address - Street 1:1085 W 71ST ST APT 26
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33014-4603
Practice Address - Country:US
Practice Address - Phone:305-316-5956
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-16
Last Update Date:2018-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL15916225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL225X00000XMedicaid