Provider Demographics
NPI:1821799339
Name:BASAIL RODRIGUEZ, VANIUSKA
Entity Type:Individual
Prefix:
First Name:VANIUSKA
Middle Name:
Last Name:BASAIL RODRIGUEZ
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 1:5521 SW 163RD CT
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33185-5113
Mailing Address - Country:US
Mailing Address - Phone:305-804-8865
Mailing Address - Fax:
Practice Address - Street 1:5521 SW 163RD CT
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33185-5113
Practice Address - Country:US
Practice Address - Phone:305-804-8865
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-13
Last Update Date:2023-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL20-127546106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician