Provider Demographics
NPI:1790950236
Name:JULIETA RODRIGUEZ PA
Entity Type:Organization
Organization Name:JULIETA RODRIGUEZ PA
Other - Org Name:GROUP
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JULIETA
Authorized Official - Middle Name:RAQUEL
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:305-672-1104
Mailing Address - Street 1:407 LINCOLN RD
Mailing Address - Street 2:#6K
Mailing Address - City:MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33139
Mailing Address - Country:US
Mailing Address - Phone:305-672-1104
Mailing Address - Fax:305-672-1385
Practice Address - Street 1:407 LINCOLN RD
Practice Address - Street 2:#6K
Practice Address - City:MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33139
Practice Address - Country:US
Practice Address - Phone:305-672-1104
Practice Address - Fax:305-672-1385
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-25
Last Update Date:2008-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ZZPY6411103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty