MEDICARE: RAIDA L RODRIGUEZ

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171100000X	Acupuncturist

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	AP3602	OTHER	FL	LICENSE NUMBER

General Provider Information

NPI Number	:	1336610906
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RAIDA L RODRIGUEZ

Provider Business Mailing Address
First Line	:	2450 SW 137TH AVE STE 207
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33175-6312
Country	:	US
Telephone Number	:	786-464-0955
Fax Number	:

Provider Business Practice Location Address
First Line	:	2450 SW 137TH AVE STE 207
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33175-6312
Country	:	US
Telephone Number	:	786-464-0955
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/07/2018
Last Update Date	:	12/07/2018

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Directions to “ RAIDA L RODRIGUEZ ” Practice Location

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