Provider Demographics
NPI:1255138079
Name:RODRIGUEZ, MARIO O
Entity type:Individual
Prefix:
First Name:MARIO
Middle Name:O
Last Name:RODRIGUEZ
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18363 NW 44TH PL
Mailing Address - Street 2:
Mailing Address - City:MIAMI GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33055-3068
Mailing Address - Country:US
Mailing Address - Phone:786-301-5711
Mailing Address - Fax:
Practice Address - Street 1:18363 NW 44TH PL
Practice Address - Street 2:
Practice Address - City:MIAMI GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33055-3068
Practice Address - Country:US
Practice Address - Phone:786-301-5711
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-27
Last Update Date:2025-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist