Provider Demographics
NPI:1487145652
Name:RODRIGUEZ, MAYLEN
Entity type:Individual
Prefix:
First Name:MAYLEN
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 1:28848 S DIXIE HWY
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33033-2405
Mailing Address - Country:US
Mailing Address - Phone:305-248-1003
Mailing Address - Fax:305-248-1009
Practice Address - Street 1:28848 S DIXIE HWY
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33033-2405
Practice Address - Country:US
Practice Address - Phone:305-248-1003
Practice Address - Fax:305-248-1009
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-23
Last Update Date:2018-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRT116152279H0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2279H0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, RegisteredHome HealthGroup - Single Specialty