Provider Demographics
NPI:1568071983
Name:RODRIGUEZ, AIDA MARIA (BARAHONA)
Entity Type:Individual
Prefix:
First Name:AIDA
Middle Name:MARIA
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:BARAHONA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16548 SW 97TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33196-5855
Mailing Address - Country:US
Mailing Address - Phone:786-227-4648
Mailing Address - Fax:
Practice Address - Street 1:16548 SW 97TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33196-5855
Practice Address - Country:US
Practice Address - Phone:786-227-4648
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-31
Last Update Date:2020-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician