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General NPI Number Information
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NPI Number | 1780628511
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Entity Type | Organization
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Legal Business Name | DANIELA RODRIGUEZ MD PLC
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Dates
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Enumeration Date | 06/15/2006
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Last Update Date | 01/15/2008
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Provider Practice Location Address
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Address Line | 21727 GREATER MACK AVE
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City | ST CLAIR SHORES
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State | MI
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Zip | 48080-2418
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Country | US
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Telephone | 586-777-7260
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Fax | 586-777-7265
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Provider Business Mailing Address
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Address Line | 21727 GREATER MACK AVE
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City | ST CLAIR SHORES
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State | MI
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Zip | 48080-2418
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Country | US
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Telephone | 586-777-7260
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Fax | 586-777-7265
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Authorized Official
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Title or Position | OWNER/PHYSICIAN
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Name | DANIELA RODRIGUEZ
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Credential | MD
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Telephone | 586-777-7260
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208200000X
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Taxonomy Name | Plastic Surgery Physician
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License Number | 4301080695
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License Number State | MI
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