Provider Demographics
NPI:1912777343
Name:LLAMOSA RODRIGUEZ, ORQUIDEA IREISDEL
Entity Type:Individual
Prefix:
First Name:ORQUIDEA
Middle Name:IREISDEL
Last Name:LLAMOSA RODRIGUEZ
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 1:501 SW 90TH CT
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33174-2343
Mailing Address - Country:US
Mailing Address - Phone:786-893-3314
Mailing Address - Fax:
Practice Address - Street 1:815 NW 57TH AVE STE 114
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33126-2041
Practice Address - Country:US
Practice Address - Phone:786-337-1451
Practice Address - Fax:305-513-5739
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-08
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL23314388106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician