Provider Demographics
NPI:1902331358
Name:LLEDO RODRIGUEZ, LAURA (BCABA)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:LLEDO RODRIGUEZ
Suffix:
Gender:F
Credentials:BCABA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9645 SW 138TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33186-7340
Mailing Address - Country:US
Mailing Address - Phone:786-907-2431
Mailing Address - Fax:
Practice Address - Street 1:9645 SW 138TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33186-7340
Practice Address - Country:US
Practice Address - Phone:786-907-2431
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-24
Last Update Date:2019-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL020639500Medicaid