Healthcare Provider Details

I. General information

NPI: 1083944052
Provider Name (Legal Business Name): JOSE MANUEL RODRIGUEZ-LEIVA APRN, FNP-BC, NP-C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/13/2010
Last Update Date: 02/01/2022
Certification Date: 02/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1150 CAMPO SANO AVE
CORAL GABLES FL
33146-1174
US

IV. Provider business mailing address

PO BOX 100905
ATLANTA GA
30384-0905
US

V. Phone/Fax

Practice location:
  • Phone: 786-268-6200
  • Fax: 786-533-9978
Mailing address:
  • Phone: 786-268-6200
  • Fax: 786-533-9978

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WR0006X
TaxonomyRegistered Nurse First Assistant
License NumberRNFA9280023
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code163WX0800X
TaxonomyOrthopedic Registered Nurse
License NumberONC82798
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11001015
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: