Individual
GRICEL RODRIGUEZ FORN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FMD
Contact information
Practice address
777 E 25TH ST, SUITE #102, HIALEAH, FL 33013-3825
(305) 984-8422
(305) 857-0070
Mailing address
PO BOX 347604, CORAL GABLES, FL 33234-7604
(305) 984-8422
(305) 857-0070
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
—
—
163WC0400X
Case Management Registered Nurse
Primary
RN9261633
FL
163WH0200X
Home Health Registered Nurse
RN9261633
FL
163WP0809X
Adult Psychiatric/Mental Health Registered Nurse
RN9261633
FL
171M00000X
Case Manager/Care Coordinator
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
758967100
—
FL
Enumeration date
06/15/2006
Last updated
03/10/2010
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