Provider Demographics
NPI:1285944397
Name:RODRIGUEZ, ANNEL KARINA (MS CCC SLP)
Entity type:Individual
Prefix:
First Name:ANNEL
Middle Name:KARINA
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:MS CCC SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8461 SW 196TH TER
Mailing Address - Street 2:
Mailing Address - City:CUTLER BAY
Mailing Address - State:FL
Mailing Address - Zip Code:33189-2022
Mailing Address - Country:US
Mailing Address - Phone:305-205-1968
Mailing Address - Fax:
Practice Address - Street 1:8461 SW 196TH TER
Practice Address - Street 2:
Practice Address - City:CUTLER BAY
Practice Address - State:FL
Practice Address - Zip Code:33189-2022
Practice Address - Country:US
Practice Address - Phone:305-205-1968
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-08
Last Update Date:2020-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA11160235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL002920400Medicaid