Provider Demographics
NPI:1639578685
Name:RODRIGUEZ-DIAZ, ELINET
Entity Type:Individual
Prefix:
First Name:ELINET
Middle Name:
Last Name:RODRIGUEZ-DIAZ
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 1:9618 CHANDON DR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32825-6131
Mailing Address - Country:US
Mailing Address - Phone:321-271-6942
Mailing Address - Fax:772-675-9100
Practice Address - Street 1:8617 E COLONIAL DR
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32817-3938
Practice Address - Country:US
Practice Address - Phone:407-895-0801
Practice Address - Fax:407-895-0803
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-15
Last Update Date:2016-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLBCBA1-14-16354103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst