Individual
WILSON RODRIGUEZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
IDC
Contact information
Practice address
19165 PURITAS AVE, CLEVELAND, OH 44135-1031
(216) 849-7987
Mailing address
19165 PURITAS AVE, CLEVELAND, OH 44135-1031
Taxonomy
Speciality
Code
Description
License number
State
1710I1002X
Independent Duty Corpsman
Primary
—
—
Other
Enumeration date
06/05/2012
Last updated
06/05/2012
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