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General NPI Number Information
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NPI Number | 1730354523
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Entity Type | Organization
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Legal Business Name | COMMUNITY PODIATRY & WOUND CARE PA
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Dates
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Enumeration Date | 04/23/2008
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Last Update Date | 01/17/2012
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Provider Practice Location Address
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Address Line | 6 SAINT JOHNS MEDICAL PARK DR
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City | ST AUGUSTINE
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State | FL
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Zip | 32086-4233
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Country | US
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Telephone | 904-823-3301
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Fax | 904-823-3328
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Provider Business Mailing Address
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Address Line | 1960 US HIGHWAY 1 SOUTH PMB 510
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City | ST AUGUSTINE
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State | FL
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Zip | 32086-4233
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Country | US
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Telephone | 904-823-3301
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Fax | 904-823-3328
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Authorized Official
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Title or Position | DOCTOR
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Name | ROSANA RODRIGUEZ
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Credential | DPM
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Telephone | 904-823-3301
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | PO2734
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License Number State | FL
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