Provider Demographics
NPI:1982447124
Name:RODRIGUEZ TEJEDA, LIANET
Entity type:Individual
Prefix:
First Name:LIANET
Middle Name:
Last Name:RODRIGUEZ TEJEDA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LIANET
Other - Middle Name:
Other - Last Name:RODRIGUEZ TEJEDA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1486 DONEGAL DR
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32940-6057
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2740 N HARBOR CITY BLVD
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32935-6291
Practice Address - Country:US
Practice Address - Phone:321-622-6884
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-15
Last Update Date:2024-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Multi-Specialty