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General NPI Number Information
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NPI Number | 1245599828
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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 | 05/16/2012
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Last Update Date | 05/16/2012
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Provider Practice Location 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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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 | OWNER
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Name | DR. HORACIO JORGE RODRIGUEZ-JIMENEZ
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Credential | M.D.
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | ACN371
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License Number State | FL
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