Provider Demographics
NPI:1598584658
Name:HERNANDEZ RODRIGUEZ, LAIDYS
Entity type:Individual
Prefix:
First Name:LAIDYS
Middle Name:
Last Name:HERNANDEZ RODRIGUEZ
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 1:8391 NW 7TH ST APT 6
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33126-3944
Mailing Address - Country:US
Mailing Address - Phone:305-753-4377
Mailing Address - Fax:
Practice Address - Street 1:8391 NW 7TH ST APT 6
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33126-3944
Practice Address - Country:US
Practice Address - Phone:305-753-4377
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-07
Last Update Date:2024-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X
FLRBT-24-363335106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician