Provider Demographics
NPI:1902233836
Name:MARK RODOLICO PA DBA MARK'S AT THE POINTE
Entity Type:Organization
Organization Name:MARK RODOLICO PA DBA MARK'S AT THE POINTE
Other - Org Name:MARK'S AT THE POINTE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:RODOLICO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:772-492-8900
Mailing Address - Street 1:46 ROYAL PALM PT
Mailing Address - Street 2:
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32960-5217
Mailing Address - Country:US
Mailing Address - Phone:772-633-6092
Mailing Address - Fax:
Practice Address - Street 1:46 ROYAL PALM PT
Practice Address - Street 2:
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32960-5217
Practice Address - Country:US
Practice Address - Phone:772-633-6092
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-09
Last Update Date:2013-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLFB0720206251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare