Healthcare Provider Details

I. General information

NPI: 1316357312
Provider Name (Legal Business Name): MED FAMILY CARE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/30/2014
Last Update Date: 09/16/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3600 NW 43RD ST SUITE D-2
GAINESVILLE FL
32606
US

IV. Provider business mailing address

3600 NW 43RD ST SUITE D-2
GAINESVILLE FL
32606-8137
US

V. Phone/Fax

Practice location:
  • Phone: 352-872-5755
  • Fax: 352-872-5102
Mailing address:
  • Phone: 787-363-3790
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberACN441
License Number StateFL

VIII. Authorized Official

Name: ISABEL RODRIGUEZ
Title or Position: OWNER
Credential: M.D.
Phone: 787-363-3790