Provider Demographics
NPI:1609372655
Name:ILLOBRE RODRIGUEZ, OVIDIO
Entity Type:Individual
Prefix:MR
First Name:OVIDIO
Middle Name:
Last Name:ILLOBRE 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 1:6065 NW 186TH ST
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33015-6099
Mailing Address - Country:US
Mailing Address - Phone:786-712-9160
Mailing Address - Fax:
Practice Address - Street 1:6065 NW 186TH ST
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33015-6099
Practice Address - Country:US
Practice Address - Phone:786-712-9160
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-30
Last Update Date:2022-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician