Provider Demographics
NPI:1790326114
Name:RODRIGUEZ, DAISY JENNIFER (BS)
Entity Type:Individual
Prefix:
First Name:DAISY
Middle Name:JENNIFER
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4221 BENNER BLDG 2
Mailing Address - Street 2:
Mailing Address - City:KYLE
Mailing Address - State:TX
Mailing Address - Zip Code:78640-2220
Mailing Address - Country:US
Mailing Address - Phone:512-596-4883
Mailing Address - Fax:
Practice Address - Street 1:4221 BENNER BLDG 2
Practice Address - Street 2:
Practice Address - City:KYLE
Practice Address - State:TX
Practice Address - Zip Code:78640-2220
Practice Address - Country:US
Practice Address - Phone:512-596-4883
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-07
Last Update Date:2019-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RBT-19-90814106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician