Basic Information
| Provider Information | |||||||||
| NPI: | 1114512506 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RODRIGUEZ | ||||||||
| FirstName: | RAZIELA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1111 E SUNRISE BLVD UNIT 50 | ||||||||
| Address2: | |||||||||
| City: | FORT LAUDERDALE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 333042847 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7863016287 | ||||||||
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| Practice Location | |||||||||
| Address1: | 5400 S UNIVERSITY DR STE 118 | ||||||||
| Address2: | |||||||||
| City: | DAVIE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 333285309 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9543785381 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/08/2021 | ||||||||
| LastUpdateDate: | 08/12/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 08/12/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | SW17307 | FL | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health | 1041C0700X | 17307 | FL | N | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.