Provider Demographics
NPI:1962878934
Name:RODRIGUEZ ROSALES, JABIER
Entity type:Individual
Prefix:
First Name:JABIER
Middle Name:
Last Name:RODRIGUEZ ROSALES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2931 SW 53RD AVE
Mailing Address - Street 2:
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33314-1942
Mailing Address - Country:US
Mailing Address - Phone:786-525-3352
Mailing Address - Fax:
Practice Address - Street 1:2931 SW 53RD AVE
Practice Address - Street 2:
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33314-1942
Practice Address - Country:US
Practice Address - Phone:786-525-3352
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-13
Last Update Date:2015-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL14365246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant