1871790246 NPI number — EMILIA RODRIGUEZ PTA

Table of content: EMILIA RODRIGUEZ PTA (NPI 1871790246)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1871790246 NPI number — EMILIA RODRIGUEZ PTA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RODRIGUEZ
Provider First Name:
EMILIA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PTA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1871790246
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/12/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 4559
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OCALA
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
34478-4559
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
352-433-0091
Provider Business Mailing Address Fax Number:
352-433-0676

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
929 N US HIGHWAY 441 STE 301
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LADY LAKE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32159-3002
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
352-433-0091
Provider Business Practice Location Address Fax Number:
352-433-0676
Provider Enumeration Date:
06/29/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225200000X , with the licence number:  PTA20870 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225100000X , with the licence number: PT33148 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)