Healthcare Provider Details

I. General information

NPI: 1851678684
Provider Name (Legal Business Name): AILEN RODRIGUEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/08/2011
Last Update Date: 11/08/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9804 SW 40TH ST
MIAMI FL
33165-3912
US

IV. Provider business mailing address

5249 NW 7TH ST APT 403
MIAMI FL
33126-3377
US

V. Phone/Fax

Practice location:
  • Phone: 305-222-9154
  • Fax: 305-222-9155
Mailing address:
  • Phone: 305-401-6216
  • Fax: 305-222-9155

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA65906
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: