Healthcare Provider Details

I. General information

NPI: 1245277607
Provider Name (Legal Business Name): JULIO RODRIGUEZ FLORIDO SAC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/02/2006
Last Update Date: 11/26/2024
Certification Date: 11/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4221 GREGORY DR
ZION IL
60099-1345
US

IV. Provider business mailing address

4221 GREGORY DR
ZION IL
60099-1345
US

V. Phone/Fax

Practice location:
  • Phone: 847-731-0627
  • Fax: 847-731-0627
Mailing address:
  • Phone: 847-731-0627
  • Fax: 847-731-0627

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License Number238000091
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number238000091
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: