Provider Demographics
NPI:1790923472
Name:RODRIGUEZ-TELLAHECHE, KARINA (SLP)
Entity Type:Individual
Prefix:
First Name:KARINA
Middle Name:
Last Name:RODRIGUEZ-TELLAHECHE
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17560 SW 88TH AVE
Mailing Address - Street 2:
Mailing Address - City:PALMETTO BAY
Mailing Address - State:FL
Mailing Address - Zip Code:33157-5827
Mailing Address - Country:US
Mailing Address - Phone:305-525-9557
Mailing Address - Fax:
Practice Address - Street 1:17560 SW 88TH AVE
Practice Address - Street 2:
Practice Address - City:PALMETTO BAY
Practice Address - State:FL
Practice Address - Zip Code:33157-5827
Practice Address - Country:US
Practice Address - Phone:305-525-9557
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-02-03
Last Update Date:2024-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA10285235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist