Provider Demographics
NPI:1679310411
Name:RODRIGUEZ BRACHO, FABIOLA ISABEL
Entity type:Individual
Prefix:
First Name:FABIOLA
Middle Name:ISABEL
Last Name:RODRIGUEZ BRACHO
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 1:6801 INTEGRA COVE BLVD APT 301
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32821-8850
Mailing Address - Country:US
Mailing Address - Phone:321-978-3581
Mailing Address - Fax:
Practice Address - Street 1:6801 INTEGRA COVE BLVD APT 301
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32821-8850
Practice Address - Country:US
Practice Address - Phone:321-978-3581
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-10
Last Update Date:2024-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-24-359985106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician