Provider Demographics
NPI:1275121337
Name:AMADOR RODRIGUEZ, JOEL
Entity Type:Individual
Prefix:
First Name:JOEL
Middle Name:
Last Name:AMADOR RODRIGUEZ
Suffix:
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 1:1131 E BROAD ST
Mailing Address - Street 2:
Mailing Address - City:ELYRIA
Mailing Address - State:OH
Mailing Address - Zip Code:44035-6305
Mailing Address - Country:US
Mailing Address - Phone:216-270-7464
Mailing Address - Fax:
Practice Address - Street 1:1131 E BROAD ST
Practice Address - Street 2:
Practice Address - City:ELYRIA
Practice Address - State:OH
Practice Address - Zip Code:44035-6305
Practice Address - Country:US
Practice Address - Phone:216-270-7464
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-05
Last Update Date:2021-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175T00000XOther Service ProvidersPeer SpecialistGroup - Single Specialty