Healthcare Provider Details

I. General information

NPI: 1821741000
Provider Name (Legal Business Name): CARLOS VLADIMIR RODRIGUEZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/28/2022
Last Update Date: 08/16/2026
Certification Date: 08/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12582 US HIGHWAY 19
HUDSON FL
34667-1952
US

IV. Provider business mailing address

5511 AVENUE DU SOLEIL
LUTZ FL
33558-2835
US

V. Phone/Fax

Practice location:
  • Phone: 727-516-8806
  • Fax:
Mailing address:
  • Phone: 813-863-5684
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number1634
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: