Provider Demographics
NPI:1053052613
Name:MORALES-RODRIGUEZ, AMBAR MARIE
Entity type:Individual
Prefix:
First Name:AMBAR
Middle Name:MARIE
Last Name:MORALES-RODRIGUEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2147
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33902-2147
Mailing Address - Country:US
Mailing Address - Phone:239-424-1900
Mailing Address - Fax:239-424-1904
Practice Address - Street 1:1138 COUNTRY CLUB BLVD
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33990-3027
Practice Address - Country:US
Practice Address - Phone:239-424-1900
Practice Address - Fax:239-424-1904
Is Sole Proprietor?:No
Enumeration Date:2022-04-06
Last Update Date:2024-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME169481207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL124370100Medicaid