Healthcare Provider Details

I. General information

NPI: 1588430771
Provider Name (Legal Business Name): ROBERTO RODRIGUEZ PEREZ ZAMORA FNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/29/2023
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5941 NW 173RD DR UNIT B-4
HIALEAH FL
33015-5109
US

IV. Provider business mailing address

5941 NW 173RD DR UNIT B-4
HIALEAH FL
33015-5109
US

V. Phone/Fax

Practice location:
  • Phone: 954-544-6411
  • Fax: 954-838-5412
Mailing address:
  • Phone: 954-544-6411
  • Fax: 954-838-5412

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11029755
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: