Provider Demographics
NPI:1700641115
Name:RODRIGUEZ BORGES, ALEXANDER (RBT)
Entity type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:
Last Name:RODRIGUEZ BORGES
Suffix:
Gender:M
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8204 PENNYWELL PL
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33615-1625
Mailing Address - Country:US
Mailing Address - Phone:813-804-8940
Mailing Address - Fax:
Practice Address - Street 1:8204 PENNYWELL PL
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33615-1625
Practice Address - Country:US
Practice Address - Phone:813-804-8940
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-15
Last Update Date:2024-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-23-317834106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty