Provider Demographics
NPI:1104630235
Name:BELIDOR, RODNEY
Entity type:Individual
Prefix:
First Name:RODNEY
Middle Name:
Last Name:BELIDOR
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 1:17560 NW 27TH AVE STE 126
Mailing Address - Street 2:
Mailing Address - City:MIAMI GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33056-4075
Mailing Address - Country:US
Mailing Address - Phone:305-684-3545
Mailing Address - Fax:
Practice Address - Street 1:17560 NW 27TH AVE STE 126
Practice Address - Street 2:
Practice Address - City:MIAMI GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33056-4075
Practice Address - Country:US
Practice Address - Phone:305-684-3545
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-07
Last Update Date:2025-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor