MEDICARE: VIVIAN M RODRIGUEZ

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171W00000X	Contractor

General Provider Information

NPI Number	:	1821336884
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VIVIAN M RODRIGUEZ

Provider Business Mailing Address
First Line	:	2707 NE 5TH PL
Second Line	:
City	:	CAPE CORAL
State	:	FL
Zip	:	33909-8820
Country	:	US
Telephone Number	:	239-443-8369
Fax Number	:

Provider Business Practice Location Address
First Line	:	2707 NE 5TH PL
Second Line	:
City	:	CAPE CORAL
State	:	FL
Zip	:	33909-8820
Country	:	US
Telephone Number	:	239-443-8369
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/26/2013
Last Update Date	:	01/26/2013

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Directions to “ VIVIAN M RODRIGUEZ ” Practice Location

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