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General NPI Number Information
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NPI Number | 1114650249
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Entity Type | Individual
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Provider Name | JOSE MARIANO RODRIGUEZ MA
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Gender | Male
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Dates
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Enumeration Date | 07/06/2022
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Last Update Date | 07/06/2022
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Provider Practice Location Address
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Address Line | 170 W 36TH ST
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City | HIALEAH
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State | FL
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Zip | 33012-5235
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Country | US
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Telephone | 786-493-8064
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Fax |
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Provider Business Mailing Address
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Address Line | 2625 COLLINS AVE APT 908
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City | MIAMI BEACH
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State | FL
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Zip | 33140-4749
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Country | US
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Telephone | 786-493-8064
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | MA63369
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License Number State | FL
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