Provider Demographics
NPI:1013599919
Name:CANELLAS DE SOUZA, RODRIGO (MD)
Entity type:Individual
Prefix:
First Name:RODRIGO
Middle Name:
Last Name:CANELLAS DE SOUZA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:RUA FAUSTOLO 1450
Mailing Address - Street 2:APT 11 TORRE 2
Mailing Address - City:SAO PAULO
Mailing Address - State:SAO PAULO
Mailing Address - Zip Code:05041001
Mailing Address - Country:BR
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1959 NE PACIFIC ST
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98195-0001
Practice Address - Country:US
Practice Address - Phone:206-543-2100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-21
Last Update Date:2021-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program