Healthcare Provider Details

I. General information

NPI: 1093621575
Provider Name (Legal Business Name): RUBEN RODRIGUEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2026
Last Update Date: 08/24/2026
Certification Date: 08/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8600 NW 41ST ST
DORAL FL
33166-6202
US

IV. Provider business mailing address

1215 W 79TH ST
HIALEAH FL
33014-3445
US

V. Phone/Fax

Practice location:
  • Phone: 305-642-5366
  • Fax:
Mailing address:
  • Phone: 786-246-9761
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberF07260559
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: