Provider Demographics
NPI:1154719706
Name:RODRIGUEZ, JOHN H
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:H
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 1:1499 W PALMETTO PARK RD
Mailing Address - Street 2:SUITE 115
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33486-3328
Mailing Address - Country:US
Mailing Address - Phone:561-417-9272
Mailing Address - Fax:561-417-9640
Practice Address - Street 1:1499 W PALMETTO PARK RD
Practice Address - Street 2:SUITE 115
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33486-3328
Practice Address - Country:US
Practice Address - Phone:561-417-9272
Practice Address - Fax:561-417-9640
Is Sole Proprietor?:No
Enumeration Date:2015-01-06
Last Update Date:2015-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL30210973374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide