Provider Demographics
NPI:1861150294
Name:BURGOS RODRIGUEZ, ILIANA MARIE I (DC)
Entity type:Individual
Prefix:
First Name:ILIANA
Middle Name:MARIE
Last Name:BURGOS RODRIGUEZ
Suffix:I
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1210 E OSCEOLA PKWY STE 302
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34744-1621
Mailing Address - Country:US
Mailing Address - Phone:407-807-0101
Mailing Address - Fax:407-807-0808
Practice Address - Street 1:1210 E OSCEOLA PKWY STE 302
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34744-1621
Practice Address - Country:US
Practice Address - Phone:404-807-0101
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-02
Last Update Date:2024-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH13811111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor