Provider Demographics
NPI:1760362859
Name:RODRIGUEZ GARCIA, YANET
Entity type:Individual
Prefix:
First Name:YANET
Middle Name:
Last Name:RODRIGUEZ GARCIA
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 1:342 SW BRIDGEPORT DR
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34953-7117
Mailing Address - Country:US
Mailing Address - Phone:772-333-4411
Mailing Address - Fax:
Practice Address - Street 1:1600 SW SYLVESTER LN
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34984-3605
Practice Address - Country:US
Practice Address - Phone:772-333-4411
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-08
Last Update Date:2025-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL25-470393106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician