Provider Demographics
NPI:1477704641
Name:RODRIGUEZ, FERNANDO (LMT)
Entity Type:Individual
Prefix:MR
First Name:FERNANDO
Middle Name:
Last Name:RODRIGUEZ
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1872 NE 46TH STREET
Mailing Address - Street 2:APT D-11
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33308-7702
Mailing Address - Country:US
Mailing Address - Phone:954-873-9548
Mailing Address - Fax:
Practice Address - Street 1:4820 N. FED HWY
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33308
Practice Address - Country:US
Practice Address - Phone:954-202-0091
Practice Address - Fax:954-202-0092
Is Sole Proprietor?:No
Enumeration Date:2008-10-07
Last Update Date:2008-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA51072225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist