Healthcare Provider Details

I. General information

NPI: 1558825232
Provider Name (Legal Business Name): PAOLA ITSASO RODRIGUEZ SANCHEZ MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/26/2019
Last Update Date: 11/12/2024
Certification Date: 11/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1975 S JOHN YOUNG PKWY STE 204
KISSIMMEE FL
34741-0603
US

IV. Provider business mailing address

900 S PINE ISLAND RD STE 800
PLANTATION FL
33324-3923
US

V. Phone/Fax

Practice location:
  • Phone: 407-249-1234
  • Fax: 407-249-1755
Mailing address:
  • Phone: 407-249-1234
  • Fax: 407-249-1755

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME169840
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: