Provider Demographics
NPI:1881587277
Name:RODRIGUEZ, LIVAN (CBHCM)
Entity type:Individual
Prefix:
First Name:LIVAN
Middle Name:
Last Name:RODRIGUEZ
Suffix:
Gender:M
Credentials:CBHCM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5826 ATLANTA ST
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33021-2718
Mailing Address - Country:US
Mailing Address - Phone:786-587-0924
Mailing Address - Fax:
Practice Address - Street 1:5826 ATLANTA ST
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021-2718
Practice Address - Country:US
Practice Address - Phone:786-587-0924
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-02
Last Update Date:2025-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator