Healthcare Provider Details

I. General information

NPI: 1952910283
Provider Name (Legal Business Name): MR. PEDRO E RODRIGUEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/22/2020
Last Update Date: 03/16/2022
Certification Date: 03/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3501 DEL PRADO BLVD S STE 303
CAPE CORAL FL
33904-7222
US

IV. Provider business mailing address

861 PALMETTO POINTE CIR
CAPE CORAL FL
33991-3608
US

V. Phone/Fax

Practice location:
  • Phone: 239-317-0265
  • Fax:
Mailing address:
  • Phone: 305-469-7761
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11008125
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN11008125
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: