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General NPI Number Information
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NPI Number | 1316549462
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Entity Type | Individual
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Provider Name | JESSICA RODRIGUEZ MAZPULE PTA
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Gender | Female
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Dates
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Enumeration Date | 11/13/2020
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Last Update Date | 11/13/2020
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Provider Practice Location Address
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Address Line | 7762 N KENDALL DR
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City | MIAMI
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State | FL
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Zip | 33156-7523
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Country | US
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Telephone | 305-598-0229
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Fax |
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Provider Business Mailing Address
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Address Line | 6100 SW 93RD CT
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City | MIAMI
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State | FL
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Zip | 33173-1532
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Country | US
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Telephone | 786-543-7428
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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 | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | PTA28032
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License Number State | FL
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