MEDICARE: EBR HEALTHCARE SERVICES LLC

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	261Q00000X	Clinic/Center

General Provider Information

NPI Number	:	1659205110
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EBR HEALTHCARE SERVICES LLC

Provider Business Mailing Address
First Line	:	9143 PANZANI PL
Second Line	:
City	:	WINDERMERE
State	:	FL
Zip	:	34786-8137
Country	:	US
Telephone Number	:	863-602-9134
Fax Number	:

Provider Business Practice Location Address
First Line	:	9143 PANZANI PL
Second Line	:
City	:	WINDERMERE
State	:	FL
Zip	:	34786-8137
Country	:	US
Telephone Number	:	863-602-9134
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT AND MANAGING MEMBER
Name	:	DR. RAQUEL RODRIGUEZ
Credential	:	MD
Telephone Number	:	863-602-9134

Provider Enumeration Date	:	06/10/2026
Last Update Date	:	06/10/2026

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