Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0700X | Prosthodontist | 25672 | TX |
NPI | 1215390216 |
---|---|
Provider Name | Dr. Noel Rodriguez |
First Address | Jacksonville, FL 32214-0001 |
Second Address | Jacksonville, FL 32214-0001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/03/2016 |
Last Update Date | 29/03/2016 |