Healthcare Provider Details

I. General information

NPI: 1033414578
Provider Name (Legal Business Name): ANA LUCIA RODRIGUEZ OT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/13/2011
Last Update Date: 01/13/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2750 SW 37TH AVE
MIAMI FL
33134-2760
US

IV. Provider business mailing address

2750 SW 37TH AVE
MIAMI FL
33134-2760
US

V. Phone/Fax

Practice location:
  • Phone: 305-642-4263
  • Fax: 305-426-3329
Mailing address:
  • Phone: 305-642-4263
  • Fax: 305-426-3329

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberOT11254
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: