Healthcare Provider Details

I. General information

NPI: 1053708313
Provider Name (Legal Business Name): RACHEL MARIE RODRIGUEZ MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/23/2015
Last Update Date: 04/01/2022
Certification Date: 02/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

246 OAKHURST CIR
KISSIMMEE FL
34744-4752
US

IV. Provider business mailing address

256 7TH AVE APT 2
BROOKLYN NY
11215-3611
US

V. Phone/Fax

Practice location:
  • Phone: 754-702-7256
  • Fax:
Mailing address:
  • Phone: 214-507-2070
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberBP10052449
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberR7868
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number036.159444
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: