Provider Demographics
NPI:1053164632
Name:RODRIGUEZ GARCIA, LISANDRA B (RBT-24-331721)
Entity type:Individual
Prefix:
First Name:LISANDRA
Middle Name:B
Last Name:RODRIGUEZ GARCIA
Suffix:
Gender:F
Credentials:RBT-24-331721
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 SE 31ST TER
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33904-3943
Mailing Address - Country:US
Mailing Address - Phone:650-664-8252
Mailing Address - Fax:
Practice Address - Street 1:1300 SE 31ST TER
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33904-3943
Practice Address - Country:US
Practice Address - Phone:650-664-8252
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-11
Last Update Date:2024-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-24-331721106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician