Provider Demographics
NPI:1942225164
Name:BALTODANO, RODRIGO (MD)
Entity type:Individual
Prefix:DR
First Name:RODRIGO
Middle Name:
Last Name:BALTODANO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:835 7TH ST BLDG B
Mailing Address - Street 2:SUITE 1
Mailing Address - City:CLERMONT
Mailing Address - State:FL
Mailing Address - Zip Code:34711-2190
Mailing Address - Country:US
Mailing Address - Phone:571-239-7193
Mailing Address - Fax:
Practice Address - Street 1:835 7TH ST BLDG B
Practice Address - Street 2:SUITE 1
Practice Address - City:CLERMONT
Practice Address - State:FL
Practice Address - Zip Code:34711-2190
Practice Address - Country:US
Practice Address - Phone:571-239-7193
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME88226207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU2677ZMedicare ID - Type Unspecified
I07031Medicare UPIN