Provider Demographics
NPI:1851748701
Name:RODRIGUEZ MORENO, REGNY
Entity Type:Individual
Prefix:
First Name:REGNY
Middle Name:
Last Name:RODRIGUEZ MORENO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7740 CAMINO REAL
Mailing Address - Street 2:APT G 301
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33143-7160
Mailing Address - Country:US
Mailing Address - Phone:786-873-3813
Mailing Address - Fax:
Practice Address - Street 1:7740 CAMINO REAL
Practice Address - Street 2:APT G 301
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33143
Practice Address - Country:US
Practice Address - Phone:786-873-3813
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-20
Last Update Date:2019-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0-18-8912106E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst