Provider Demographics
NPI:1306870704
Name:MATEO, RODRIGO BLEZA (MD)
Entity type:Individual
Prefix:DR
First Name:RODRIGO
Middle Name:BLEZA
Last Name:MATEO
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:311 NORTH CLYDE MORRIS BLVD., SUITE 480
Mailing Address - Street 2:HALIFAX CENTER FOR TRANSPLANT SERVICES
Mailing Address - City:DAYTONA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32114-2766
Mailing Address - Country:US
Mailing Address - Phone:386-947-4650
Mailing Address - Fax:386-947-4690
Practice Address - Street 1:311 NORTH CLYDE MORRIS BLVD., SUITE 480
Practice Address - Street 2:HALIFAX CENTER FOR TRANSPLANT SERVICES
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32114-2766
Practice Address - Country:US
Practice Address - Phone:386-947-4650
Practice Address - Fax:386-947-4690
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2009-12-02
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Provider Licenses
StateLicense IDTaxonomies
FLME104900208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL001299700Medicaid
FLCG291ZMedicare PIN
FLG98737Medicare UPIN