Healthcare Provider Details

I. General information

NPI: 1699322867
Provider Name (Legal Business Name): RDM PROFESSIONAL SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/22/2019
Last Update Date: 08/29/2025
Certification Date: 08/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

777 W DUVAL ST
LAKE CITY FL
32055-5806
US

IV. Provider business mailing address

437 SW ROSEMARY DR
LAKE CITY FL
32024-6715
US

V. Phone/Fax

Practice location:
  • Phone: 386-755-3300
  • Fax: 386-935-4331
Mailing address:
  • Phone: 973-610-6389
  • Fax: 386-935-4331

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RA0000X
TaxonomyAdolescent Medicine (Internal Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: ROLANDO DOMINGUEZ MUSTAFA
Title or Position: OWNER
Credential: MD
Phone: 973-610-6389