Healthcare Provider Details

I. General information

NPI: 1700157906
Provider Name (Legal Business Name): JESUS S RODRIGUEZ, M.D. P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/19/2012
Last Update Date: 01/19/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

142 E 49TH ST
HIALEAH FL
33013-1853
US

IV. Provider business mailing address

142 E 49TH ST
HIALEAH FL
33013-1853
US

V. Phone/Fax

Practice location:
  • Phone: 305-822-1993
  • Fax: 305-826-3788
Mailing address:
  • Phone: 305-822-1993
  • Fax: 305-826-3788

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberME0033464
License Number StateFL

VIII. Authorized Official

Name: DR. JESUS SILVESTRE RODRIGUEZ
Title or Position: PRESIDENT
Credential: M.D.
Phone: 305-822-1993