Healthcare Provider Details

I. General information

NPI: 1588580278
Provider Name (Legal Business Name): MARIELYS RODRIGUEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2026
Last Update Date: 06/26/2026
Certification Date: 06/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5030 BRUNSON DR
CORAL GABLES FL
33146-2412
US

IV. Provider business mailing address

11552 SW 187TH TER
MIAMI FL
33157-6537
US

V. Phone/Fax

Practice location:
  • Phone: 786-282-3860
  • Fax:
Mailing address:
  • Phone: 786-282-3860
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: