Provider Demographics
NPI:1366164394
Name:RODRIGUEZ, IVETT
Entity type:Individual
Prefix:
First Name:IVETT
Middle Name:
Last Name:RODRIGUEZ
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 1:12747 SW 60TH LN # IN
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33183-1349
Mailing Address - Country:US
Mailing Address - Phone:305-308-3528
Mailing Address - Fax:
Practice Address - Street 1:12747 SW 60TH LN # IN
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33183-1349
Practice Address - Country:US
Practice Address - Phone:305-308-3528
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-15
Last Update Date:2022-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RBT-21-170697106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
RBT-21-170697OtherREGISTERED BEHAVIOR TECHNICIAN