Provider Demographics
NPI:1982130506
Name:BUSTAQUE RODRIGUEZ, YANELIS M (APRN, RBT)
Entity Type:Individual
Prefix:
First Name:YANELIS
Middle Name:M
Last Name:BUSTAQUE RODRIGUEZ
Suffix:
Gender:F
Credentials:APRN, RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8700 NW 171 TERRA
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33018-4263
Mailing Address - Country:US
Mailing Address - Phone:786-857-2940
Mailing Address - Fax:
Practice Address - Street 1:8700 NW 171 TERRA
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33018
Practice Address - Country:US
Practice Address - Phone:786-857-2940
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-02
Last Update Date:2023-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103K00000X, 106S00000X
FL11021770363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician