Provider Demographics
NPI:1881360162
Name:RODRIGUEZ LEDESMA, JANNY
Entity type:Individual
Prefix:
First Name:JANNY
Middle Name:
Last Name:RODRIGUEZ LEDESMA
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 1:500 NE 2ND ST APT 328
Mailing Address - Street 2:
Mailing Address - City:DANIA
Mailing Address - State:FL
Mailing Address - Zip Code:33004-3374
Mailing Address - Country:US
Mailing Address - Phone:786-657-5881
Mailing Address - Fax:
Practice Address - Street 1:777 N NOB HILL RD
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33324-1028
Practice Address - Country:US
Practice Address - Phone:754-322-5700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-18
Last Update Date:2025-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1881360162106S00000X
FL1801473913106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician