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Individual

MIGUEL ANTONIO RODRIGUEZ JR.

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
IDMT

Contact information

Practice address
690 BARNES BLVD, JOINT BASE LEWIS MCCHORD, WA 98438-1303
(180) 040-4450
Mailing address
19330 18TH AVENUE CT E, SPANAWAY, WA 98387-8590

Taxonomy

Speciality
Code
Description
License number
State
1710I1003X
Independent Duty Medical Technicians
Primary

Other

Enumeration date
12/16/2018
Last updated
12/16/2018
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