Provider Demographics
NPI:1588273197
Name:RODRIGUEZ VALIDO, YANNELIS
Entity type:Individual
Prefix:
First Name:YANNELIS
Middle Name:
Last Name:RODRIGUEZ VALIDO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10845 SAKONNET RIVER DR
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33615-3368
Mailing Address - Country:US
Mailing Address - Phone:727-333-0608
Mailing Address - Fax:
Practice Address - Street 1:3309 W WATERS AVE STE A
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33614-2766
Practice Address - Country:US
Practice Address - Phone:813-898-0014
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-29
Last Update Date:2020-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
20-129407106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician