Provider Demographics
NPI:1942711072
Name:RODRIGUEZ, JOSE LORENZO
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:LORENZO
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 1:1898 NW 69TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33147-6914
Mailing Address - Country:US
Mailing Address - Phone:786-797-3804
Mailing Address - Fax:305-693-1614
Practice Address - Street 1:1898 NW 69TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33147-6914
Practice Address - Country:US
Practice Address - Phone:786-797-3804
Practice Address - Fax:305-693-1614
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-16
Last Update Date:2017-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)