Healthcare Provider Details

I. General information

NPI: 1780780841
Provider Name (Legal Business Name): ISABEL RODRIGUEZ MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2006
Last Update Date: 08/13/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3600 NW 43RD ST STE D2
GAINESVILLE FL
32606-8127
US

IV. Provider business mailing address

3600 NW 43RD ST STE D2
GAINESVILLE FL
32606-8127
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number16599
License Number StatePR
# 2
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberACN441
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: