Provider Demographics
NPI:1962280487
Name:RODRIGUEZ SOSA, JAVIER (SA-C)
Entity type:Individual
Prefix:
First Name:JAVIER
Middle Name:
Last Name:RODRIGUEZ SOSA
Suffix:
Gender:M
Credentials:SA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3308 COLLIN DR
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33406-5095
Mailing Address - Country:US
Mailing Address - Phone:561-906-8052
Mailing Address - Fax:
Practice Address - Street 1:3308 COLLIN DR
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33406-5095
Practice Address - Country:US
Practice Address - Phone:561-906-8052
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-18
Last Update Date:2023-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL23-593246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant