Provider Demographics
NPI:1053658625
Name:GALVAN, RODOLFO CARLO (DMS, CVT, RT)
Entity Type:Individual
Prefix:
First Name:RODOLFO
Middle Name:CARLO
Last Name:GALVAN
Suffix:
Gender:M
Credentials:DMS, CVT, RT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11855 SW 208TH TER
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33177-7008
Mailing Address - Country:US
Mailing Address - Phone:305-964-5521
Mailing Address - Fax:
Practice Address - Street 1:11855 SW 208TH TER
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33177-7008
Practice Address - Country:US
Practice Address - Phone:305-964-5521
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-15
Last Update Date:2013-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL31772282N00000X
FL450718282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital