Provider Demographics
NPI:1689412629
Name:RODRIGUEZ GONZALEZ, YANEISY DE LA CARIDAD
Entity type:Individual
Prefix:
First Name:YANEISY
Middle Name:DE LA CARIDAD
Last Name:RODRIGUEZ GONZALEZ
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 1:3345 SW 26TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33133-2027
Mailing Address - Country:US
Mailing Address - Phone:786-506-6196
Mailing Address - Fax:
Practice Address - Street 1:3345 SW 26TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33133-2027
Practice Address - Country:US
Practice Address - Phone:786-506-6196
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-15
Last Update Date:2024-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL24-351054106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician