Provider Demographics
NPI:1952169096
Name:RODRIGUEZ DOMINGUEZ, MARICARMEN
Entity Type:Individual
Prefix:
First Name:MARICARMEN
Middle Name:
Last Name:RODRIGUEZ DOMINGUEZ
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 1:10246 SW 227TH ST
Mailing Address - Street 2:
Mailing Address - City:CUTLER BAY
Mailing Address - State:FL
Mailing Address - Zip Code:33190-1747
Mailing Address - Country:US
Mailing Address - Phone:772-282-3898
Mailing Address - Fax:
Practice Address - Street 1:10246 SW 227TH ST
Practice Address - Street 2:
Practice Address - City:CUTLER BAY
Practice Address - State:FL
Practice Address - Zip Code:33190-1747
Practice Address - Country:US
Practice Address - Phone:772-282-3898
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-12
Last Update Date:2024-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician