Provider Demographics
NPI:1932745106
Name:RODRIGUEZ, GIOVANNA JULEISI
Entity type:Individual
Prefix:MS
First Name:GIOVANNA
Middle Name:JULEISI
Last Name: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 1:5078 S UNIVERSITY DR
Mailing Address - Street 2:
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33328-4509
Mailing Address - Country:US
Mailing Address - Phone:786-616-0939
Mailing Address - Fax:
Practice Address - Street 1:500 NE SPANISH RIVER BLVD STE 31
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33431-4517
Practice Address - Country:US
Practice Address - Phone:561-563-3738
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-22
Last Update Date:2024-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician