Provider Demographics
NPI:1386359586
Name:RODRIGUEZ, RONALD
Entity type:Individual
Prefix:MR
First Name:RONALD
Middle Name:
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 1:540 MEADOW BEND DR
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:FL
Mailing Address - Zip Code:33837-5872
Mailing Address - Country:US
Mailing Address - Phone:305-772-3983
Mailing Address - Fax:
Practice Address - Street 1:220 W BRANDON BLVD # 210-A
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-5104
Practice Address - Country:US
Practice Address - Phone:305-772-3983
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-23
Last Update Date:2023-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLR362-720-95-386-0OtherDRIVER LICENSE