Provider Demographics
NPI:1093275315
Name:RODRIGUEZ, MYAVA (DC)
Entity type:Individual
Prefix:DR
First Name:MYAVA
Middle Name:
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1954 W STATE ROAD 426 STE 1112
Mailing Address - Street 2:
Mailing Address - City:OVIEDO
Mailing Address - State:FL
Mailing Address - Zip Code:32765-8831
Mailing Address - Country:US
Mailing Address - Phone:407-723-0090
Mailing Address - Fax:
Practice Address - Street 1:1954 W STATE ROAD 426 STE 1112
Practice Address - Street 2:
Practice Address - City:OVIEDO
Practice Address - State:FL
Practice Address - Zip Code:32765-8831
Practice Address - Country:US
Practice Address - Phone:407-723-0090
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-22
Last Update Date:2019-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH12722111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor