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General NPI Number Information
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NPI Number | 1073611067
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Entity Type | Organization
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Legal Business Name | MARIANNA FAMILY CARE CENTER LLC
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Dates
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Enumeration Date | 09/21/2006
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Last Update Date | 01/26/2011
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Provider Practice Location Address
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Address Line | 2928 DANIELS STREET
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City | MARIANNA
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State | FL
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Zip | 32446
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Country | US
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Telephone | 850-526-3555
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Fax | 850-526-3570
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Provider Business Mailing Address
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Address Line | 2928 DANIELS ST
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City | MARIANNA
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State | FL
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Zip | 32446-2912
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Country | US
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Telephone | 850-526-3555
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Fax | 850-526-3570
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | MR. HORACIO JORGE RODRIGUEZ-JIMENEZ
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Credential | MD
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Telephone | 850-526-3555
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | ME61655
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License Number State | FL
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