Provider Demographics
NPI:1053159400
Name:MARTIN RODRIGUEZ, ARIANNA DE LA CARIDAD
Entity type:Individual
Prefix:
First Name:ARIANNA
Middle Name:DE LA CARIDAD
Last Name:MARTIN 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 1:911 CLAYTON AVE
Mailing Address - Street 2:
Mailing Address - City:LEHIGH ACRES
Mailing Address - State:FL
Mailing Address - Zip Code:33972-7403
Mailing Address - Country:US
Mailing Address - Phone:786-444-9317
Mailing Address - Fax:
Practice Address - Street 1:911 CLAYTON AVE
Practice Address - Street 2:
Practice Address - City:LEHIGH ACRES
Practice Address - State:FL
Practice Address - Zip Code:33972-7403
Practice Address - Country:US
Practice Address - Phone:786-444-9317
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-18
Last Update Date:2024-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL24-340468106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty