Provider Demographics
NPI:1467006320
Name:RODRIGUEZ-MABRY, MARYCELL
Entity Type:Individual
Prefix:
First Name:MARYCELL
Middle Name:
Last Name:RODRIGUEZ-MABRY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4710 COPPOLA DR
Mailing Address - Street 2:
Mailing Address - City:MOUNT DORA
Mailing Address - State:FL
Mailing Address - Zip Code:32757-8069
Mailing Address - Country:US
Mailing Address - Phone:407-407-5238
Mailing Address - Fax:
Practice Address - Street 1:4710 COPPOLA DR
Practice Address - Street 2:
Practice Address - City:MOUNT DORA
Practice Address - State:FL
Practice Address - Zip Code:32757-8069
Practice Address - Country:US
Practice Address - Phone:407-407-5238
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-30
Last Update Date:2019-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)