Individual
TALISA RODRIGUEZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
1215 N HARBOR CITY BLVD, MELBOURNE, FL 32935-7020
(321) 220-0600
Mailing address
1215 N HARBOR CITY BLVD, MELBOURNE, FL 32935-7020
Taxonomy
Speciality
Code
Description
License number
State
156FX1800X
Optician
Primary
7498
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
DO7498
PROFESSIONAL LICENSE NUMBER
FL
Enumeration date
11/18/2020
Last updated
11/18/2020
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