Provider Demographics
NPI:1750890661
Name:ESTRADA RODRIGO, DENNIS
Entity type:Individual
Prefix:
First Name:DENNIS
Middle Name:
Last Name:ESTRADA RODRIGO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1149 INDEPENDENCE TRL APT K
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33034-2610
Mailing Address - Country:US
Mailing Address - Phone:786-459-6422
Mailing Address - Fax:
Practice Address - Street 1:1149 INDEPENDENCE TRAIL APT K
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33034
Practice Address - Country:US
Practice Address - Phone:786-459-6422
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-22
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL18-69692106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician