Provider Demographics
NPI:1649888355
Name:RODRIGUEZ, JOGE EDUARDO (RBT)
Entity type:Individual
Prefix:
First Name:JOGE
Middle Name:EDUARDO
Last Name:RODRIGUEZ
Suffix:
Gender:M
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:918 NE 92ND ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI SHORES
Mailing Address - State:FL
Mailing Address - Zip Code:33138-2911
Mailing Address - Country:US
Mailing Address - Phone:305-496-0782
Mailing Address - Fax:
Practice Address - Street 1:12905 SW 42ND ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33175-2905
Practice Address - Country:US
Practice Address - Phone:786-558-4091
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-20
Last Update Date:2020-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1997279106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician