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General NPI Number Information
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NPI Number | 1841887841
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Entity Type | Individual
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Provider Name | INDIRA MULET RODRIGUEZ SA-C
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Gender | Female
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Dates
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Enumeration Date | 12/23/2020
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Last Update Date | 12/23/2020
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Provider Practice Location Address
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Address Line | 10820 SW 200TH DR APT 406S
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City | CUTLER BAY
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State | FL
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Zip | 33157-8432
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Country | US
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Telephone | 305-680-6592
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Fax |
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Provider Business Mailing Address
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Address Line | 10820 SW 200TH DR APT 406S
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City | CUTLER BAY
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State | FL
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Zip | 33157-8432
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Country | US
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Telephone | 305-680-6592
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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 | 246ZC0007X
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Taxonomy Name | Surgical Assistant
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License Number | 19-304
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License Number State | WI
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