Provider Demographics
NPI:1588011191
Name:RODRIGUEZ RODRIGUEZ, NEMESIO G
Entity Type:Individual
Prefix:
First Name:NEMESIO
Middle Name:G
Last Name:RODRIGUEZ RODRIGUEZ
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 1:14854 SW 148TH STREET CIR STE 201
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33196-2309
Mailing Address - Country:US
Mailing Address - Phone:786-366-5209
Mailing Address - Fax:
Practice Address - Street 1:12485 SW 137TH AVE STE 106
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33186-4215
Practice Address - Country:US
Practice Address - Phone:786-250-4423
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-24
Last Update Date:2022-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1-17-27615103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst