Miguel Antonio Rodriguez Jr., IDMT
Military Health Care Provider, Independent Duty Medical Technicians in Joint Base Lewis McChord, WA. Individual provider (NPI-1).
NPI number1982175113
StatusActive
Last updated in NPPESDec 16, 2018
Details
- NPI
- 1982175113
- Entity type
- Individual (NPI-1)
- Name
- Miguel Antonio Rodriguez Jr.
- Credential
- IDMT
- Sex
- Male
- Sole proprietor
- No
- Enumeration date
- Dec 16, 2018
- Last updated
- Dec 16, 2018
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 1710I1003X | Military Health Care Provider, Independent Duty Medical Technicians | – | – | Yes |
Practice location
690 Barnes BlvdJoint Base Lewis McChord, WA 98438-1303
Phone 180-040-4450
Mailing address
19330 18th Avenue Ct ESpanaway, WA 98387-8590
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