Provider Demographics
NPI:1932894508
Name:RODRIGUEZ GUTIERREZ, ROCIO DALIA
Entity type:Individual
Prefix:
First Name:ROCIO
Middle Name:DALIA
Last Name:RODRIGUEZ GUTIERREZ
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 1:8240 SW 149TH CT APT 203
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33193-3102
Mailing Address - Country:US
Mailing Address - Phone:786-357-0144
Mailing Address - Fax:
Practice Address - Street 1:8240 SW 149TH CT APT 203
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33193-3102
Practice Address - Country:US
Practice Address - Phone:786-357-0144
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-10
Last Update Date:2024-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL222Q00000X
376K00000X
FLRBT-23-308261106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist
No376K00000XNursing Service Related ProvidersNurse's Aide