Provider Demographics
NPI:1154013860
Name:SANTANA BRENE, RODE
Entity type:Individual
Prefix:
First Name:RODE
Middle Name:
Last Name:SANTANA BRENE
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 1:20251 SW 130TH CT
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33177-6124
Mailing Address - Country:US
Mailing Address - Phone:786-593-1717
Mailing Address - Fax:
Practice Address - Street 1:14201 SW 120TH ST STE 110
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33186-7662
Practice Address - Country:US
Practice Address - Phone:786-803-8826
Practice Address - Fax:786-803-8954
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-22
Last Update Date:2023-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician