Healthcare Provider Details

I. General information

NPI: 1376021436
Provider Name (Legal Business Name): JENNIFER LISSELLE RODRIGUEZ-BELEN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/01/2018
Last Update Date: 09/17/2025
Certification Date: 09/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5647 HOLLYWOOD BLVD
HOLLYWOOD FL
33021-6325
US

IV. Provider business mailing address

2900 CORPORATE WAY # D
MIRAMAR FL
33025-3925
US

V. Phone/Fax

Practice location:
  • Phone: 954-276-1616
  • Fax:
Mailing address:
  • Phone: 954-276-1616
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License NumberME175656
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: