Provider Demographics
NPI:1740791235
Name:RODRIGUEZ SUAREZ, YASER (CASE MANAGER)
Entity Type:Individual
Prefix:
First Name:YASER
Middle Name:
Last Name:RODRIGUEZ SUAREZ
Suffix:
Gender:M
Credentials:CASE MANAGER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16128 SW 68TH TER
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33193-3490
Mailing Address - Country:US
Mailing Address - Phone:786-217-8617
Mailing Address - Fax:
Practice Address - Street 1:900 E 9TH ST
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33010-4650
Practice Address - Country:US
Practice Address - Phone:305-381-5294
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-24
Last Update Date:2023-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL171M00000X, 104100000X
FLRBT-20-125222106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLRBT-20-125222OtherRBT CERTIFICATION NUMBER
FLCBHCM100436OtherCBHCM
FLCBHCMS100540OtherCBHCMS