Provider Demographics
NPI:1588399729
Name:RODRIGUEZ ROSALES, DEISY M (RBT)
Entity type:Individual
Prefix:
First Name:DEISY
Middle Name:M
Last Name:RODRIGUEZ ROSALES
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1221 S DIXIE HWY W APT 208
Mailing Address - Street 2:
Mailing Address - City:POMPANO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33060-8823
Mailing Address - Country:US
Mailing Address - Phone:954-513-7783
Mailing Address - Fax:
Practice Address - Street 1:6807 W COMMERCIAL BLVD
Practice Address - Street 2:
Practice Address - City:LAUDERHILL
Practice Address - State:FL
Practice Address - Zip Code:33319-2116
Practice Address - Country:US
Practice Address - Phone:754-444-4171
Practice Address - Fax:754-444-4167
Is Sole Proprietor?:No
Enumeration Date:2022-07-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-22-214799106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL114398600Medicaid