Healthcare Provider Details

I. General information

NPI: 1801130059
Provider Name (Legal Business Name): GABRIEL EDGARDO RODRIGUEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/11/2012
Last Update Date: 07/09/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

235 CITRUS TOWER BLVD STE 106
CLERMONT FL
34711-2712
US

IV. Provider business mailing address

215 SHUMAN BLVD STE. 401
NAPERVILLE IL
60563-8458
US

V. Phone/Fax

Practice location:
  • Phone: 352-243-1212
  • Fax: 352-243-6474
Mailing address:
  • Phone: 630-303-5380
  • Fax: 978-313-6824

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License NumberAS4893
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: