Provider Demographics
NPI:1427453133
Name:RODRIGUEZ, GREYSI
Entity type:Individual
Prefix:
First Name:GREYSI
Middle Name:
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:GREYSI
Other - Middle Name:
Other - Last Name:PEREZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1699 NW 4TH AVE APT 505
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33136-1565
Mailing Address - Country:US
Mailing Address - Phone:786-523-1124
Mailing Address - Fax:
Practice Address - Street 1:2500 NW 107TH AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33172-5925
Practice Address - Country:US
Practice Address - Phone:305-846-9807
Practice Address - Fax:305-846-9711
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-24
Last Update Date:2020-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL103K00000X, 390200000X
FL1-20-46187103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL018143000Medicaid