Provider Demographics
NPI:1871940486
Name:VAZQUEZ RODRIGUEZ, MILITZA
Entity type:Individual
Prefix:
First Name:MILITZA
Middle Name:
Last Name:VAZQUEZ 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 1:840 SW 105TH AVE APT 318
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33174-2632
Mailing Address - Country:US
Mailing Address - Phone:305-224-2335
Mailing Address - Fax:
Practice Address - Street 1:5923 SW 137TH CT
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33183-2021
Practice Address - Country:US
Practice Address - Phone:305-224-2335
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-24
Last Update Date:2022-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106E00000X, 106S00000X, 171W00000X
FL103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No171W00000XOther Service ProvidersContractor