Provider Demographics
NPI:1457876518
Name:CABRERA RODRIGUEZ, MAIDELYS
Entity Type:Individual
Prefix:
First Name:MAIDELYS
Middle Name:
Last Name:CABRERA 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 1:20319 SW 3RD ST
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33029-5027
Mailing Address - Country:US
Mailing Address - Phone:786-514-6881
Mailing Address - Fax:
Practice Address - Street 1:20319 SW 3RD ST
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33029-5027
Practice Address - Country:US
Practice Address - Phone:786-514-6881
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-10
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician