Provider Demographics
NPI:1093563397
Name:RODRIGUEZ REYES, NANCY BARBARA
Entity type:Individual
Prefix:
First Name:NANCY BARBARA
Middle Name:
Last Name:RODRIGUEZ REYES
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 1:1500 NE MIAMI PL APT 1810
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33132-1597
Mailing Address - Country:US
Mailing Address - Phone:786-655-1138
Mailing Address - Fax:
Practice Address - Street 1:1500 NE MIAMI PL APT 1810
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33132-1597
Practice Address - Country:US
Practice Address - Phone:786-655-1138
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-10
Last Update Date:2024-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-24-345796106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty