Provider Demographics
NPI:1710754593
Name:RODRIGUEZ RUIZ, MELISSA M
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:M
Last Name:RODRIGUEZ RUIZ
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 1:401 CRESCENT DR APT 26
Mailing Address - Street 2:
Mailing Address - City:MIAMI SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33166-5861
Mailing Address - Country:US
Mailing Address - Phone:781-666-1553
Mailing Address - Fax:
Practice Address - Street 1:401 CRESCENT DR APT 26
Practice Address - Street 2:
Practice Address - City:MIAMI SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33166-5861
Practice Address - Country:US
Practice Address - Phone:781-666-1553
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-11
Last Update Date:2023-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician