Provider Demographics
NPI:1558024612
Name:RODRIGUEZ SALAZAR, ROLANDO A
Entity Type:Individual
Prefix:
First Name:ROLANDO
Middle Name:A
Last Name:RODRIGUEZ SALAZAR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6126 NW 181ST TERRACE CIR W
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33015-5625
Mailing Address - Country:US
Mailing Address - Phone:956-510-6978
Mailing Address - Fax:
Practice Address - Street 1:6126 NW 181ST TERRACE CIR W
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33015-5625
Practice Address - Country:US
Practice Address - Phone:956-510-6978
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-15
Last Update Date:2024-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-20-133148106S00000X
103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician