Provider Demographics
NPI:1891521761
Name:RODRIGUEZ, MARIA DE LOS MILAGRO JIMENEZ (LMT)
Entity type:Individual
Prefix:
First Name:MARIA DE LOS MILAGRO
Middle Name:JIMENEZ
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 N HIATUS RD STE 206
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33026-3026
Mailing Address - Country:US
Mailing Address - Phone:786-290-0713
Mailing Address - Fax:
Practice Address - Street 1:1000 N HIATUS RD STE 206
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33026-3026
Practice Address - Country:US
Practice Address - Phone:786-290-0713
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-09
Last Update Date:2024-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL102556225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist