Provider Demographics
NPI:1679280234
Name:RODRIGUEZ, PAIGE MIRANDA (RBT)
Entity Type:Individual
Prefix:
First Name:PAIGE
Middle Name:MIRANDA
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:472 NATURES WAY
Mailing Address - Street 2:
Mailing Address - City:WEST MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32904-7703
Mailing Address - Country:US
Mailing Address - Phone:321-831-8302
Mailing Address - Fax:
Practice Address - Street 1:5830 US HIGHWAY 1 STE 102
Practice Address - Street 2:
Practice Address - City:ROCKLEDGE
Practice Address - State:FL
Practice Address - Zip Code:32955-5704
Practice Address - Country:US
Practice Address - Phone:321-609-9007
Practice Address - Fax:321-765-6434
Is Sole Proprietor?:No
Enumeration Date:2022-11-03
Last Update Date:2022-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician