Provider Demographics
NPI:1619672698
Name:RODRIGUEZ HERNANDEZ, LISDANAY
Entity Type:Individual
Prefix:
First Name:LISDANAY
Middle Name:
Last Name:RODRIGUEZ HERNANDEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2122 SW 97TH CT
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33165-7518
Mailing Address - Country:US
Mailing Address - Phone:786-728-1668
Mailing Address - Fax:
Practice Address - Street 1:2122 SW 97TH CT
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33165-7518
Practice Address - Country:US
Practice Address - Phone:786-728-1668
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-31
Last Update Date:2023-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst