Provider Demographics
NPI:1679394993
Name:PINZON RODRIGUEZ, NELLY CAROLINA (LAC)
Entity type:Individual
Prefix:
First Name:NELLY
Middle Name:CAROLINA
Last Name:PINZON RODRIGUEZ
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1630 SW 28TH WAY
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33312-3961
Mailing Address - Country:US
Mailing Address - Phone:786-302-1971
Mailing Address - Fax:
Practice Address - Street 1:130 N DIXIE HWY
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33020-6704
Practice Address - Country:US
Practice Address - Phone:954-258-7643
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-19
Last Update Date:2024-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP4607171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist