Provider Demographics
NPI:1265446918
Name:RODRIGO BALTODANO INC
Entity Type:Organization
Organization Name:RODRIGO BALTODANO INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RODRIGO
Authorized Official - Middle Name:
Authorized Official - Last Name:BALTODANO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:352-394-0043
Mailing Address - Street 1:3125 CITRUS TOWER BLVD
Mailing Address - Street 2:
Mailing Address - City:CLERMONT
Mailing Address - State:FL
Mailing Address - Zip Code:34711-6803
Mailing Address - Country:US
Mailing Address - Phone:352-394-0043
Mailing Address - Fax:352-394-0640
Practice Address - Street 1:3125 CITRUS TOWER BOULEVARD
Practice Address - Street 2:BLDG C
Practice Address - City:CLERMONT
Practice Address - State:FL
Practice Address - Zip Code:34711
Practice Address - Country:US
Practice Address - Phone:352-394-0043
Practice Address - Fax:352-394-0640
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-28
Last Update Date:2011-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME88226207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL6179630001OtherDMEPOS
I07031Medicare UPIN
K8226Medicare ID - Type UnspecifiedGRP
FL6179630001Medicare NSC
FL6179630001OtherDMEPOS