Provider Demographics
NPI:1578011292
Name:RODRIGUEZ REINA, CARIDAD
Entity Type:Individual
Prefix:
First Name:CARIDAD
Middle Name:
Last Name:RODRIGUEZ REINA
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 1:11401 SW 40TH ST STE 270
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33165-3348
Mailing Address - Country:US
Mailing Address - Phone:786-907-4925
Mailing Address - Fax:786-907-4972
Practice Address - Street 1:11401 SW 40TH ST STE 270
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33165-3348
Practice Address - Country:US
Practice Address - Phone:786-907-4925
Practice Address - Fax:786-907-4972
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-12
Last Update Date:2022-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0-19-9769106E00000X
FLRBT-18-67680106S00000X
171M00000X
FL1-21-54802103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL021354600Medicaid