Provider Demographics
NPI:1104239656
Name:RODRIGUEZ, BRANDON ALEXANDER
Entity type:Individual
Prefix:MR
First Name:BRANDON
Middle Name:ALEXANDER
Last Name: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 1:14902 SW 11TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33194-2505
Mailing Address - Country:US
Mailing Address - Phone:305-978-6550
Mailing Address - Fax:
Practice Address - Street 1:9280 HAMMOCKS BLVD STE 101
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33196-1594
Practice Address - Country:US
Practice Address - Phone:305-752-0220
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-03
Last Update Date:2014-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst