Provider Demographics
NPI:1821239195
Name:RODRIGUEZ, JUAN CARLOS
Entity Type:Individual
Prefix:MR
First Name:JUAN
Middle Name:CARLOS
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 1:6595 NW 36TH ST
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33166-6979
Mailing Address - Country:US
Mailing Address - Phone:305-874-7160
Mailing Address - Fax:305-874-7162
Practice Address - Street 1:6595 NW 36TH ST
Practice Address - Street 2:SUITE 301
Practice Address - City:VIRGINIA GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33166-6979
Practice Address - Country:US
Practice Address - Phone:305-874-7160
Practice Address - Fax:305-874-7162
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-17
Last Update Date:2009-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health