Provider Demographics
NPI:1235218199
Name:RODRIGUEZ, BLANCA ROSA (LMT)
Entity Type:Individual
Prefix:MRS
First Name:BLANCA
Middle Name:ROSA
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:2100 W 76TH ST
Mailing Address - Street 2:413
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33016-5539
Mailing Address - Country:US
Mailing Address - Phone:305-400-8091
Mailing Address - Fax:305-400-8185
Practice Address - Street 1:2100 W 76TH ST
Practice Address - Street 2:413
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33016-5539
Practice Address - Country:US
Practice Address - Phone:305-400-8091
Practice Address - Fax:305-400-8185
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-03
Last Update Date:2011-07-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FL698769816246RP1900X
FLMA 45172225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy