MEDICARE: EMANUEL RODRIGUEZ

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	IMH29225	FL

General Provider Information

NPI Number	:	1215864152
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EMANUEL RODRIGUEZ

Provider Business Mailing Address
First Line	:	4641 SW 136TH PL
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33175-3718
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4641 SW 136TH PL
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33175-3718
Country	:	US
Telephone Number	:	305-587-8023
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/05/2026
Last Update Date	:	05/05/2026

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Directions to “ EMANUEL RODRIGUEZ ” Practice Location

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