Provider Demographics
NPI:1396571261
Name:RODRIGUEZ GONZALEZ, OVIDIO JESUS
Entity type:Individual
Prefix:
First Name:OVIDIO
Middle Name:JESUS
Last Name:RODRIGUEZ GONZALEZ
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 1:18424 SW 293RD TER
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33030-2446
Mailing Address - Country:US
Mailing Address - Phone:786-255-5385
Mailing Address - Fax:
Practice Address - Street 1:18424 SW 293RD TER
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33030-2446
Practice Address - Country:US
Practice Address - Phone:786-255-5385
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-09
Last Update Date:2024-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL24-366654106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician