Provider Demographics
NPI:1649856865
Name:MACIQUES RODRIGUEZ, ELAIME (MASTER)
Entity type:Individual
Prefix:MISS
First Name:ELAIME
Middle Name:
Last Name:MACIQUES RODRIGUEZ
Suffix:
Gender:F
Credentials:MASTER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10055 SW 222ND ST
Mailing Address - Street 2:
Mailing Address - City:CUTLER BAY
Mailing Address - State:FL
Mailing Address - Zip Code:33190-1564
Mailing Address - Country:US
Mailing Address - Phone:786-838-7523
Mailing Address - Fax:
Practice Address - Street 1:11500 QUAIL ROOST DR
Practice Address - Street 2:
Practice Address - City:CUTLER BAY
Practice Address - State:FL
Practice Address - Zip Code:33157-6548
Practice Address - Country:US
Practice Address - Phone:786-838-7523
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-18
Last Update Date:2022-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLBT-20-119557106S00000X
FL222Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL106484200Medicaid