Healthcare Provider Details

I. General information

NPI: 1992156251
Provider Name (Legal Business Name): ARTURO RODRIGUEZ JR.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2016
Last Update Date: 07/12/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4175 W 20TH AVE
HIALEAH FL
33012
US

IV. Provider business mailing address

4175 W 20TH AVE ROOM 239
HIALEAH FL
33012-5874
US

V. Phone/Fax

Practice location:
  • Phone: 305-424-3030
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberTRN23700
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberTRN23700
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: