Healthcare Provider Details

I. General information

NPI: 1740262146
Provider Name (Legal Business Name): RODRIGO ANGEL
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/19/2005
Last Update Date: 09/01/2021
Certification Date: 09/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

440 N STATE ROAD 7 STE 103
ROYAL PALM BEACH FL
33411-3504
US

IV. Provider business mailing address

10131 W. FOREST HILL BLVD STE 230
WEST PALM BEACH FL
33414
US

V. Phone/Fax

Practice location:
  • Phone: 561-798-6600
  • Fax: 561-615-1958
Mailing address:
  • Phone: 561-798-6600
  • Fax: 561-204-2042

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code246ZS0410X
TaxonomySurgical Technologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11014730
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN11014730
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: