Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RE0101X | Endocrinologist (Diabetes Doctor) | 143708 | FL |
NPI | 1083008544 |
---|---|
Provider Name | Dr. Gracielena Rodriguez |
First Address | Port St Lucie, FL 34984-3654 |
Second Address | Stuart, FL 34994-3504 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/03/2015 |
Last Update Date | 08/11/2021 |