Provider Demographics
NPI:1730555855
Name:RODRIGUEZ, MOISES
Entity type:Individual
Prefix:MR
First Name:MOISES
Middle Name:
Last Name:RODRIGUEZ
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 1:7880 YORK RD
Mailing Address - Street 2:
Mailing Address - City:PARMA
Mailing Address - State:OH
Mailing Address - Zip Code:44130-7314
Mailing Address - Country:US
Mailing Address - Phone:216-925-9992
Mailing Address - Fax:440-886-1599
Practice Address - Street 1:7880 YORK RD
Practice Address - Street 2:
Practice Address - City:PARMA
Practice Address - State:OH
Practice Address - Zip Code:44130-7314
Practice Address - Country:US
Practice Address - Phone:216-925-9992
Practice Address - Fax:440-886-1599
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-12
Last Update Date:2015-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide