Provider Demographics
NPI:1750081600
Name:RODRIGUEZ SUAREZ, CHAVELI
Entity type:Individual
Prefix:
First Name:CHAVELI
Middle Name:
Last Name:RODRIGUEZ SUAREZ
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 1:1080 S MILITARY TRL APT 104
Mailing Address - Street 2:
Mailing Address - City:DEERFIELD BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33442-7691
Mailing Address - Country:US
Mailing Address - Phone:786-848-5190
Mailing Address - Fax:
Practice Address - Street 1:1080 S MILITARY TRL APT 104
Practice Address - Street 2:
Practice Address - City:DEERFIELD BEACH
Practice Address - State:FL
Practice Address - Zip Code:33442-7691
Practice Address - Country:US
Practice Address - Phone:786-848-5190
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-08
Last Update Date:2023-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RBT-23-259558106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician