Provider Demographics
NPI:1609685858
Name:RODRIGUEZ HERNANDEZ, LAURA ELENA
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:ELENA
Last Name:RODRIGUEZ HERNANDEZ
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 1:5970 HILLYER CT
Mailing Address - Street 2:
Mailing Address - City:N FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33903-4515
Mailing Address - Country:US
Mailing Address - Phone:239-910-9289
Mailing Address - Fax:
Practice Address - Street 1:5970 HILLYER CT
Practice Address - Street 2:
Practice Address - City:N FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33903-4515
Practice Address - Country:US
Practice Address - Phone:239-910-9289
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-02
Last Update Date:2025-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-24-366236106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician