Provider Demographics
NPI:1407647241
Name:RODRIGUEZ, YADIESKA
Entity type:Individual
Prefix:
First Name:YADIESKA
Middle Name:
Last Name: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 1:2010 NW 207TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33056-1640
Mailing Address - Country:US
Mailing Address - Phone:912-602-8623
Mailing Address - Fax:912-602-8623
Practice Address - Street 1:2010 NW 207TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33056-1640
Practice Address - Country:US
Practice Address - Phone:912-602-8623
Practice Address - Fax:912-602-8623
Is Sole Proprietor?:No
Enumeration Date:2025-05-13
Last Update Date:2025-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLBACB1034855106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician