Provider Demographics
NPI:1770146730
Name:RODRIGUEZ, MAYNOR R
Entity type:Individual
Prefix:
First Name:MAYNOR
Middle Name:R
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:PO BOX 2438
Mailing Address - Street 2:
Mailing Address - City:HAZLETON
Mailing Address - State:PA
Mailing Address - Zip Code:18201-8438
Mailing Address - Country:US
Mailing Address - Phone:570-497-4070
Mailing Address - Fax:570-300-1802
Practice Address - Street 1:328 E BROAD ST APT 1
Practice Address - Street 2:
Practice Address - City:HAZLETON
Practice Address - State:PA
Practice Address - Zip Code:18201-6650
Practice Address - Country:US
Practice Address - Phone:570-497-4070
Practice Address - Fax:570-300-1802
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-16
Last Update Date:2019-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No343800000XTransportation ServicesSecured Medical Transport (VAN)
No347B00000XTransportation ServicesBus
No347C00000XTransportation ServicesPrivate Vehicle