Provider Demographics
NPI:1598370322
Name:DUARTE RODRIGUEZ, FAUSTO
Entity Type:Individual
Prefix:
First Name:FAUSTO
Middle Name:
Last Name:DUARTE 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 1:8625 NW 8TH ST APT 103
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33126-5903
Mailing Address - Country:US
Mailing Address - Phone:786-385-8432
Mailing Address - Fax:
Practice Address - Street 1:8625 NW 8TH ST APT 103
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33126-5903
Practice Address - Country:US
Practice Address - Phone:786-385-8432
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-09
Last Update Date:2020-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician