Provider Demographics
NPI:1093253015
Name:RODRIGUEZ, HECTOR L JR
Entity Type:Individual
Prefix:
First Name:HECTOR
Middle Name:L
Last Name:RODRIGUEZ
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 E MONUMENT AVE
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34741-5761
Mailing Address - Country:US
Mailing Address - Phone:407-350-4138
Mailing Address - Fax:321-250-7463
Practice Address - Street 1:105 E MONUMENT AVE
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34741-5761
Practice Address - Country:US
Practice Address - Phone:407-350-4138
Practice Address - Fax:321-250-7463
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-09
Last Update Date:2021-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251E00000XAgenciesHome Health
No172V00000XOther Service ProvidersCommunity Health WorkerGroup - Single Specialty
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Single Specialty