Healthcare Provider Details

I. General information

NPI: 1093253015
Provider Name (Legal Business Name): HECTOR L RODRIGUEZ JR.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/09/2017
Last Update Date: 07/10/2021
Certification Date: 07/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 E MONUMENT AVE
KISSIMMEE FL
34741-5761
US

IV. Provider business mailing address

105 E MONUMENT AVE
KISSIMMEE FL
34741-5761
US

V. Phone/Fax

Practice location:
  • Phone: 407-350-4138
  • Fax: 321-250-7463
Mailing address:
  • Phone: 407-350-4138
  • Fax: 321-250-7463

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: