Healthcare Provider Details

I. General information

NPI: 1225263023
Provider Name (Legal Business Name): GERARDO UMABEL RODRIGUEZ L.M.T.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/21/2009
Last Update Date: 05/21/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12290 DARTMOOR DR
WELLINGTON FL
33414-5530
US

IV. Provider business mailing address

12290 DARTMOOR DR
WELLINGTON FL
33414-5530
US

V. Phone/Fax

Practice location:
  • Phone: 561-302-9897
  • Fax: 561-795-4443
Mailing address:
  • Phone: 561-302-9897
  • Fax: 561-795-4443

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number24978
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: