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General NPI Number Information
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NPI Number | 1699322867
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Entity Type | Organization
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Legal Business Name | RDM PROFESSIONAL SERVICES, INC.
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Dates
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Enumeration Date | 08/22/2019
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Last Update Date | 08/29/2025
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Provider Practice Location Address
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Address Line | 777 W DUVAL ST
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City | LAKE CITY
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State | FL
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Zip | 32055-5806
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Country | US
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Telephone | 386-755-3300
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Fax | 386-935-4331
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Provider Business Mailing Address
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Address Line | 437 SW ROSEMARY DR
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City | LAKE CITY
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State | FL
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Zip | 32024-6715
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Country | US
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Telephone | 973-610-6389
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Fax | 386-935-4331
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Authorized Official
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Title or Position | OWNER
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Name | ROLANDO DOMINGUEZ MUSTAFA
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Credential | MD
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Telephone | 973-610-6389
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RA0000X
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Taxonomy Name | Adolescent Medicine (Internal Medicine) Physician
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License Number |
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License Number State |
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