Provider Demographics
NPI:1265907505
Name:RODRIGUEZ, NARCISO
Entity type:Individual
Prefix:MR
First Name:NARCISO
Middle Name:
Last Name:RODRIGUEZ
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 1:11890 SW 8TH ST STE 309
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33184-1710
Mailing Address - Country:US
Mailing Address - Phone:305-220-6060
Mailing Address - Fax:888-247-5059
Practice Address - Street 1:11890 SW 8TH ST STE 309
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33184-1710
Practice Address - Country:US
Practice Address - Phone:305-220-6060
Practice Address - Fax:888-247-5059
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-12
Last Update Date:2018-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL018713400Medicaid