=====================================================
General NPI Number Information
=====================================================
NPI Number | 1225590177
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | WITHMYDOC, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/01/2019
-----------------------------------------------------
Last Update Date | 08/12/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4111 SW 47TH AVE STE 319
-----------------------------------------------------
City | DAVIE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33314-4038
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-691-1650
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 13798 NW 4TH ST STE 311
-----------------------------------------------------
City | SUNRISE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33325-6227
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 786-621-2910
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | RICHARD RODRIGUEZ
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 786-621-2910
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 171M00000X
-----------------------------------------------------
Taxonomy Name | Case Manager/Care Coordinator
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------