Provider Demographics
NPI:1255020780
Name:RODRIGUEZ, MAILEN (AP)
Entity type:Individual
Prefix:
First Name:MAILEN
Middle Name:
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:AP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18952 SW 113TH PL
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33157-7564
Mailing Address - Country:US
Mailing Address - Phone:786-218-1140
Mailing Address - Fax:
Practice Address - Street 1:11285 SW 211TH ST STE 305
Practice Address - Street 2:
Practice Address - City:CUTLER BAY
Practice Address - State:FL
Practice Address - Zip Code:33189-2213
Practice Address - Country:US
Practice Address - Phone:786-980-7496
Practice Address - Fax:918-238-1914
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-02
Last Update Date:2023-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP4448171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist