Individual
IVAN LAVANDERA RODRIGUEZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1995 E OAKLAND PARK BLVD STE 310, FT LAUDERDALE, FL 33306-1138
(954) 791-6146
Mailing address
13533 SW 62ND ST APT 3, MIAMI, FL 33183-5094
(716) 423-3042
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
15-528
FL
363L00000X
Nurse Practitioner
Primary
11012299
FL
Other
Enumeration date
04/13/2016
Last updated
04/05/2021
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