Provider Demographics
NPI:1578281499
Name:RODRIGUEZ, JAIRO ANDRES
Entity Type:Individual
Prefix:
First Name:JAIRO
Middle Name:ANDRES
Last Name: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 1:6061 COLLINS AVE APT 4B
Mailing Address - Street 2:
Mailing Address - City:MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33140-2267
Mailing Address - Country:US
Mailing Address - Phone:305-798-0275
Mailing Address - Fax:
Practice Address - Street 1:6061 COLLINS AVE APT 4B
Practice Address - Street 2:
Practice Address - City:MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33140-2267
Practice Address - Country:US
Practice Address - Phone:305-798-0275
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-16
Last Update Date:2022-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA86749225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist