Provider Demographics
NPI:1619398419
Name:RODRIGUEZ, MIRIAM JOCELYN (PHD)
Entity Type:Individual
Prefix:
First Name:MIRIAM
Middle Name:JOCELYN
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2173 NW 99TH AVE
Mailing Address - Street 2:
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33172-2231
Mailing Address - Country:US
Mailing Address - Phone:305-593-1223
Mailing Address - Fax:
Practice Address - Street 1:2173 NW 99TH AVE
Practice Address - Street 2:
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33172-2231
Practice Address - Country:US
Practice Address - Phone:305-593-1223
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-12-20
Last Update Date:2018-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY9391103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist