Provider Demographics
NPI:1528849544
Name:RODRIGUEZ DE LA TORRE, JOEL DAVID
Entity type:Individual
Prefix:
First Name:JOEL
Middle Name:DAVID
Last Name:RODRIGUEZ DE LA TORRE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1955 BEACON LANDING CIR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32824-4366
Mailing Address - Country:US
Mailing Address - Phone:786-385-3650
Mailing Address - Fax:
Practice Address - Street 1:1955 BEACON LANDING CIR
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32824-4366
Practice Address - Country:US
Practice Address - Phone:786-385-3650
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-06
Last Update Date:2023-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL23300707106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician