Provider Demographics
NPI:1689545238
Name:GARCIA RODRIGUEZ, DIANELIS
Entity type:Individual
Prefix:
First Name:DIANELIS
Middle Name:
Last Name:GARCIA RODRIGUEZ
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 1:3927 TOWNSHIP SQUARE BLVD APT 1523
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32837-5395
Mailing Address - Country:US
Mailing Address - Phone:786-754-4820
Mailing Address - Fax:
Practice Address - Street 1:3927 TOWNSHIP SQUARE BLVD APT 1523
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32837-5395
Practice Address - Country:US
Practice Address - Phone:786-754-4820
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-16
Last Update Date:2025-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-25-467750106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician