Provider Demographics
NPI:1184487399
Name:RODRIGUEZ DAVILA, YAIMARA
Entity type:Individual
Prefix:
First Name:YAIMARA
Middle Name:
Last Name:RODRIGUEZ DAVILA
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 1:7421 ROCKWOOD DR
Mailing Address - Street 2:
Mailing Address - City:PORT RICHEY
Mailing Address - State:FL
Mailing Address - Zip Code:34668-3987
Mailing Address - Country:US
Mailing Address - Phone:407-694-1155
Mailing Address - Fax:
Practice Address - Street 1:7421 ROCKWOOD DR
Practice Address - Street 2:
Practice Address - City:PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34668-3987
Practice Address - Country:US
Practice Address - Phone:407-694-1155
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-31
Last Update Date:2024-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-24-323372106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician