Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RP1001X | Pulmonary Disease | ME61778 | FL |
NPI | 1053300590 |
---|---|
Provider Name | Antonio L. Rodriguez |
First Address | Longwood, FL 32750-5162 |
Second Address | Longwood, FL 32750-5162 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/10/2005 |
Last Update Date | 08/10/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
250303400 | (05) | FL |
G02169 | (02) | FL |