MEDICARE: DR. RODRIGO BALTODANO MD

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	207R00000X	Internal Medicine Physician	ME88226	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1942225164
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RODRIGO BALTODANO MD

Provider Business Mailing Address
First Line	:	835 7TH ST BLDG B
Second Line	:	SUITE 1
City	:	CLERMONT
State	:	FL
Zip	:	34711-2190
Country	:	US
Telephone Number	:	571-239-7193
Fax Number	:

Provider Business Practice Location Address
First Line	:	835 7TH ST BLDG B
Second Line	:	SUITE 1
City	:	CLERMONT
State	:	FL
Zip	:	34711-2190
Country	:	US
Telephone Number	:	571-239-7193
Fax Number	:

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

Provider Enumeration Date	:	07/12/2006
Last Update Date	:	07/08/2007

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