Healthcare Provider Details

I. General information

NPI: 1033642376
Provider Name (Legal Business Name): EDELYN RODRIGUEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/04/2017
Last Update Date: 04/04/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9921 W OKEECHOBEE RD APT 523D
HIALEAH FL
33016-2136
US

IV. Provider business mailing address

9921 W OKEECHOBEE RD APT 523D
HIALEAH FL
33016-2136
US

V. Phone/Fax

Practice location:
  • Phone: 786-277-6568
  • Fax:
Mailing address:
  • Phone: 786-277-6568
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: