Provider Demographics
NPI:1114735958
Name:FLORES RODRIGUEZ, LIZ DANIELA
Entity type:Individual
Prefix:
First Name:LIZ
Middle Name:DANIELA
Last Name:FLORES 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 1:721 LORI DR APT 307
Mailing Address - Street 2:
Mailing Address - City:PALM SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33461-1243
Mailing Address - Country:US
Mailing Address - Phone:561-644-6908
Mailing Address - Fax:
Practice Address - Street 1:721 LORI DR APT 307
Practice Address - Street 2:
Practice Address - City:PALM SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33461-1243
Practice Address - Country:US
Practice Address - Phone:561-644-6908
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-26
Last Update Date:2024-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-24-400840106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician