Provider Demographics
NPI:1366124976
Name:DIAZ RODRIGUEZ, ERICK JAVIER
Entity type:Individual
Prefix:
First Name:ERICK
Middle Name:JAVIER
Last Name:DIAZ 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 1:7420 W 20TH AVE APT 255
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33016-5545
Mailing Address - Country:US
Mailing Address - Phone:786-710-6148
Mailing Address - Fax:
Practice Address - Street 1:1140 W 50TH ST STE 303
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-3411
Practice Address - Country:US
Practice Address - Phone:305-231-3371
Practice Address - Fax:305-231-3382
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-02
Last Update Date:2023-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL23-282527106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician