Provider Demographics
NPI:1457461196
Name:RODRIGUEZ, MARIA C (PHD)
Entity Type:Individual
Prefix:DR
First Name:MARIA
Middle Name:C
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6625 MIAMI LAKES DR
Mailing Address - Street 2:SUITE 377
Mailing Address - City:MIAMI LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33014-2708
Mailing Address - Country:US
Mailing Address - Phone:305-779-8593
Mailing Address - Fax:305-779-8598
Practice Address - Street 1:6625 MIAMI LAKES DR
Practice Address - Street 2:SUITE 377
Practice Address - City:MIAMI LAKES
Practice Address - State:FL
Practice Address - Zip Code:33014-2708
Practice Address - Country:US
Practice Address - Phone:305-779-8593
Practice Address - Fax:305-779-8598
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2010-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY0004566103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL28145OtherHEALTH EASE PROVIDER ID
FL080182OtherVALUE OPTIONS MHS NUMBER
FL084496OtherMHN PROVIDER NUMBER
FL208564OtherAV MED PROVIDER ID
FL10680OtherDIMENSION HEALTH PROVIDER
FL9047512OtherPHES PJD NUMBER
FL73940Medicare ID - Type Unspecified