Healthcare Provider Details

I. General information

NPI: 1376186437
Provider Name (Legal Business Name): ANISSA RODRIGUEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANISSA DELTORO

II. Dates (important events)

Enumeration Date: 10/22/2019
Last Update Date: 05/26/2022
Certification Date: 05/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5300 W HILLSBORO BLVD
COCONUT CREEK FL
33073-4395
US

IV. Provider business mailing address

9054 NW 14TH CT
PEMBROKE PINES FL
33024-4601
US

V. Phone/Fax

Practice location:
  • Phone: 954-725-4141
  • Fax:
Mailing address:
  • Phone: 954-895-8649
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberAPRN11004695
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11004695
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: