Healthcare Provider Details

I. General information

NPI: 1790606200
Provider Name (Legal Business Name): RODRIGO MACEDO DE QUEIROZ
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/22/2026
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7050 W PALMETTO PARK RD STE 17
BOCA RATON FL
33433-3462
US

IV. Provider business mailing address

10 SE 13TH ST APT B1
BOCA RATON FL
33432-7016
US

V. Phone/Fax

Practice location:
  • Phone: 561-368-2111
  • Fax:
Mailing address:
  • Phone: 916-591-5263
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number109688
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: