Provider Demographics
NPI:1538754494
Name:RODRIGUEZ TORRES, LETICIA
Entity type:Individual
Prefix:
First Name:LETICIA
Middle Name:
Last Name:RODRIGUEZ TORRES
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 1:71 DAVIS RD
Mailing Address - Street 2:
Mailing Address - City:PALM SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33461-2911
Mailing Address - Country:US
Mailing Address - Phone:561-207-0608
Mailing Address - Fax:
Practice Address - Street 1:71 DAVIS RD
Practice Address - Street 2:
Practice Address - City:PALM SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33461-2911
Practice Address - Country:US
Practice Address - Phone:561-207-0608
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-03
Last Update Date:2021-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL21-155876106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician