Provider Demographics
NPI:1366124141
Name:RODRIGUEZ LOPEZ, MAYLIN (RBT-23-286783)
Entity type:Individual
Prefix:
First Name:MAYLIN
Middle Name:
Last Name:RODRIGUEZ LOPEZ
Suffix:
Gender:F
Credentials:RBT-23-286783
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14415 SW 88TH ST APT G207
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33186-1006
Mailing Address - Country:US
Mailing Address - Phone:786-776-9328
Mailing Address - Fax:305-896-3784
Practice Address - Street 1:14415 SW 88TH ST APT G207
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33186-1006
Practice Address - Country:US
Practice Address - Phone:786-776-9328
Practice Address - Fax:305-896-3784
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-02
Last Update Date:2023-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician