Basic Information
| Provider Information | |||||||||
| NPI: | 1124446869 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ZAMORA RENDICH | ||||||||
| FirstName: | RODOLFO | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 909 | ||||||||
| Address2: | |||||||||
| City: | LOUISVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 402010909 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5025880328 | ||||||||
| FaxNumber: | 5025874784 | ||||||||
| Practice Location | |||||||||
| Address1: | 234 E GRAY ST STE 564 | ||||||||
| Address2: | |||||||||
| City: | LOUISVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 402021914 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5026295460 | ||||||||
| FaxNumber: | 5026295461 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/31/2014 | ||||||||
| LastUpdateDate: | 01/11/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/11/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | FL048 | KY | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | 207X00000X | TR 60540337 | WA | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
ID Information
| ID | Type | State | Issuer | Description | 201397840 | 05 | IN | MEDICAID | 7100422940 | 05 | KY | MEDICAID |