Provider Demographics
NPI:1801621446
Name:CARVAJAL RODRIGUEZ, JOSE ARIEL
Entity type:Individual
Prefix:
First Name:JOSE
Middle Name:ARIEL
Last Name:CARVAJAL RODRIGUEZ
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 1:17234 NW 48TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33055-4211
Mailing Address - Country:US
Mailing Address - Phone:786-825-9456
Mailing Address - Fax:
Practice Address - Street 1:17234 NW 48TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33055-4211
Practice Address - Country:US
Practice Address - Phone:786-825-9456
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-04
Last Update Date:2024-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician