Provider Demographics
NPI:1427876630
Name:AQUINO RODRIGUEZ, ISIS (EBT)
Entity type:Individual
Prefix:
First Name:ISIS
Middle Name:
Last Name:AQUINO RODRIGUEZ
Suffix:
Gender:F
Credentials:EBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7701 SW 88TH ST APT B328
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33156-7594
Mailing Address - Country:US
Mailing Address - Phone:954-669-2826
Mailing Address - Fax:
Practice Address - Street 1:7701 SW 88TH ST APT B328
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33156-7594
Practice Address - Country:US
Practice Address - Phone:954-669-2826
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-27
Last Update Date:2024-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-24-376771106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician