Provider Demographics
NPI:1972384121
Name:RODRIGUEZ, JUAN CARLOS
Entity Type:Individual
Prefix:
First Name:JUAN CARLOS
Middle Name:
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 1:1980 S OCEAN DR APT 16L
Mailing Address - Street 2:
Mailing Address - City:HALLANDALE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33009-5937
Mailing Address - Country:US
Mailing Address - Phone:305-244-5523
Mailing Address - Fax:
Practice Address - Street 1:1980 S OCEAN DR APT 16L
Practice Address - Street 2:
Practice Address - City:HALLANDALE BEACH
Practice Address - State:FL
Practice Address - Zip Code:33009-5937
Practice Address - Country:US
Practice Address - Phone:305-244-5523
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-12
Last Update Date:2023-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide