Provider Demographics
NPI:1952021685
Name:HERNANDEZ RODRIGUEZ, FRANK E
Entity Type:Individual
Prefix:
First Name:FRANK
Middle Name:E
Last Name:HERNANDEZ 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 1:1261 SE 6TH AVE APT 206H
Mailing Address - Street 2:
Mailing Address - City:DEERFIELD BCH
Mailing Address - State:FL
Mailing Address - Zip Code:33441-6965
Mailing Address - Country:US
Mailing Address - Phone:979-257-7906
Mailing Address - Fax:
Practice Address - Street 1:1261 SE 6TH AVE APT 206H
Practice Address - Street 2:
Practice Address - City:DEERFIELD BCH
Practice Address - State:FL
Practice Address - Zip Code:33441-6965
Practice Address - Country:US
Practice Address - Phone:979-257-7906
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-01
Last Update Date:2022-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-22-223159106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty