Provider Demographics
NPI:1942181284
Name:RODRIGUEZ GOMEZ, SUSANA
Entity type:Individual
Prefix:
First Name:SUSANA
Middle Name:
Last Name:RODRIGUEZ GOMEZ
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 1:1109 MARTIN BLVD
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32825-6460
Mailing Address - Country:US
Mailing Address - Phone:754-736-5711
Mailing Address - Fax:
Practice Address - Street 1:1109 MARTIN BLVD
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32825-6460
Practice Address - Country:US
Practice Address - Phone:754-736-5711
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-11
Last Update Date:2025-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-25-471872106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician