Provider Demographics
NPI:1134742422
Name:ABADIA RODRIGUEZ, ISIS YANIELISSEE
Entity type:Individual
Prefix:MISS
First Name:ISIS
Middle Name:YANIELISSEE
Last Name:ABADIA 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 1:1401 VILLAGE BLVD APT 1325
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33409-2767
Mailing Address - Country:US
Mailing Address - Phone:787-988-9193
Mailing Address - Fax:
Practice Address - Street 1:911 E ATLANTIC BLVD STE 108A
Practice Address - Street 2:
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33060-7372
Practice Address - Country:US
Practice Address - Phone:561-941-2323
Practice Address - Fax:954-692-9184
Is Sole Proprietor?:No
Enumeration Date:2020-05-21
Last Update Date:2020-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician