Provider Demographics
NPI:1871160762
Name:RODRIGUEZ BRAVO, OLGA
Entity type:Individual
Prefix:
First Name:OLGA
Middle Name:
Last Name:RODRIGUEZ BRAVO
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 1:4939 SW 129TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33175-5305
Mailing Address - Country:US
Mailing Address - Phone:786-426-7474
Mailing Address - Fax:
Practice Address - Street 1:4939 SW 129TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33175-5305
Practice Address - Country:US
Practice Address - Phone:786-426-7474
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-08
Last Update Date:2021-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-21-164876106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician