Provider Demographics
NPI:1215939673
Name:RODRIGUEZ, DANIELA MARIA
Entity type:Individual
Prefix:DR
First Name:DANIELA
Middle Name:MARIA
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21727 MACK AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT CLAIR SHORES
Mailing Address - State:MI
Mailing Address - Zip Code:48080-2418
Mailing Address - Country:US
Mailing Address - Phone:586-777-7260
Mailing Address - Fax:586-777-7265
Practice Address - Street 1:21727 MACK AVE
Practice Address - Street 2:
Practice Address - City:SAINT CLAIR SHORES
Practice Address - State:MI
Practice Address - Zip Code:48080-2418
Practice Address - Country:US
Practice Address - Phone:586-777-7260
Practice Address - Fax:586-777-7265
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-15
Last Update Date:2009-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301080695208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIH61010Medicare UPIN