Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | ME0065756 | FL |
NPI | 1003859315 |
---|---|
Provider Name | Rodolfo Hanabergh |
First Address | Miami, FL 33155 |
Second Address | Miami, FL 33155-1419 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/06/2006 |
Last Update Date | 14/09/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
E75626 | (02) |