Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | DN15859 | FL |
NPI | 1003950502 |
---|---|
Provider Name | Dr. Hernan M Rodriguez |
First Address | Miami, FL 33133-0000 |
Second Address | Miami Beach, FL 33139-5504 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/02/2007 |
Last Update Date | 12/09/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0760242001 | (05) | FL |