Basic Information
| Provider Information | |||||||||
| NPI: | 1639667207 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HERNANDEZ RODRIGUEZ | ||||||||
| FirstName: | LETICIA | ||||||||
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| Credential: | BCABA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10453 SW 99TH TER | ||||||||
| Address2: | |||||||||
| City: | MIAMI | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331762725 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7862029326 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2615 FAIRWAYS DR | ||||||||
| Address2: | |||||||||
| City: | HOMESTEAD | ||||||||
| State: | FL | ||||||||
| PostalCode: | 330351173 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3055973861 | ||||||||
| FaxNumber: | 3055973863 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/28/2018 | ||||||||
| LastUpdateDate: | 09/26/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 09/26/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103K00000X | 0-21-12753 | FL | N | Behavioral Health & Social Service Providers | Behavioral Analyst | 106S00000X | RBT-18-53247 | FL | N | 106E00000X | 0-21-12753 | FL | Y | 193400000X SINGLE SPECIALTY GROUP |
No ID Information.