Healthcare Provider Details

I. General information

NPI: 1164358263
Provider Name (Legal Business Name): PEDRO JESUS ALONSO RODRIGUEZ APRN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2026
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5539 SW 8TH ST
CORAL GABLES FL
33134-2266
US

IV. Provider business mailing address

15595 SW 57TH ST
MIAMI FL
33193-2513
US

V. Phone/Fax

Practice location:
  • Phone: 305-833-0053
  • Fax:
Mailing address:
  • Phone: 786-728-3379
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11048577
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: