Provider Demographics
NPI:1770871360
Name:RODRIGUEZ, INALDO LAZARO (LMT)
Entity type:Individual
Prefix:MR
First Name:INALDO
Middle Name:LAZARO
Last Name:RODRIGUEZ
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9436 SW 5TH LN
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33174-2114
Mailing Address - Country:US
Mailing Address - Phone:305-370-9408
Mailing Address - Fax:
Practice Address - Street 1:9436 SW 5TH LN
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33174-2114
Practice Address - Country:US
Practice Address - Phone:305-370-9408
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-16
Last Update Date:2011-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLLMT 31170171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171W00000XOther Service ProvidersContractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLLMT 31170OtherINDEPENDENT