Provider Demographics
NPI:1386950830
Name:RODRIGUEZ, MATIAS (MS)
Entity type:Individual
Prefix:
First Name:MATIAS
Middle Name:
Last Name:RODRIGUEZ
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2187 BARRACUDA AVE
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32951-2909
Mailing Address - Country:US
Mailing Address - Phone:321-795-2703
Mailing Address - Fax:
Practice Address - Street 1:1127 S PATRICK DR
Practice Address - Street 2:SUITE 24
Practice Address - City:SATELLITE BEACH
Practice Address - State:FL
Practice Address - Zip Code:32937-3939
Practice Address - Country:US
Practice Address - Phone:321-773-1111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-22
Last Update Date:2010-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program