Healthcare Provider Details

I. General information

NPI: 1417391731
Provider Name (Legal Business Name): FRANK R RODRIGUEZ SR. MS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/18/2013
Last Update Date: 04/18/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1320 N. SEMORAN BLVD. SUITE 200
ORLANDO FL
32807-3561
US

IV. Provider business mailing address

1320 N. SEMORAN BLVD. SUITE 200
ORLANDO FL
32807-3561
US

V. Phone/Fax

Practice location:
  • Phone: 407-704-7811
  • Fax: 407-382-0659
Mailing address:
  • Phone: 407-704-7811
  • Fax: 407-382-0659

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: