Provider Demographics
NPI:1275649451
Name:RODRIGUEZ, HUMBERTO (DC)
Entity Type:Individual
Prefix:
First Name:HUMBERTO
Middle Name:
Last Name:RODRIGUEZ
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2724 PONCE DE LEON BLVD
Mailing Address - Street 2:
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33134-6005
Mailing Address - Country:US
Mailing Address - Phone:786-360-6355
Mailing Address - Fax:786-536-4319
Practice Address - Street 1:2724 PONCE DE LEON BLVD
Practice Address - Street 2:
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33134-6005
Practice Address - Country:US
Practice Address - Phone:786-360-6355
Practice Address - Fax:786-536-4219
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2012-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL5710111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU44142Medicare UPIN