Provider Demographics
NPI:1598999138
Name:RODRIGUEZ, LIUBA (MSED)
Entity Type:Individual
Prefix:
First Name:LIUBA
Middle Name:
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:MSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4205 SW 6TH AVE
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33914-5880
Mailing Address - Country:US
Mailing Address - Phone:347-418-6148
Mailing Address - Fax:
Practice Address - Street 1:4205 SW 6TH AVE
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33914-5880
Practice Address - Country:US
Practice Address - Phone:347-418-6148
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-12
Last Update Date:2009-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist