MEDICARE: MR. RAFAEL 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	247ZC0005X	Clinical Laboratory Director (Non-physician)	ME61793	FL

General Provider Information

NPI Number	:	1972756955
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. RAFAEL RODRIGUEZ

Provider Business Mailing Address
First Line	:	8004 NW 154TH ST # 197
Second Line	:
City	:	MIAMI LAKES
State	:	FL
Zip	:	33016-5814
Country	:	US
Telephone Number	:	786-290-8419
Fax Number	:

Provider Business Practice Location Address
First Line	:	8004 NW 154TH ST # 197
Second Line	:
City	:	MIAMI LAKES
State	:	FL
Zip	:	33016-5814
Country	:	US
Telephone Number	:	786-290-8419
Fax Number	:

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

Provider Enumeration Date	:	11/04/2008
Last Update Date	:	11/04/2008

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