Provider Demographics
NPI:1417757212
Name:RODRIGUEZ LLERENA, DALLANA
Entity type:Individual
Prefix:
First Name:DALLANA
Middle Name:
Last Name:RODRIGUEZ LLERENA
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10001 BAHIA LOOP
Mailing Address - Street 2:
Mailing Address - City:LAND O LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:34639-2668
Mailing Address - Country:US
Mailing Address - Phone:786-399-4396
Mailing Address - Fax:
Practice Address - Street 1:10001 BAHIA LOOP
Practice Address - Street 2:
Practice Address - City:LAND O LAKES
Practice Address - State:FL
Practice Address - Zip Code:34639-2668
Practice Address - Country:US
Practice Address - Phone:786-399-4396
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-19
Last Update Date:2025-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-25-420544106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician