Healthcare Provider Details

I. General information

NPI: 1629057914
Provider Name (Legal Business Name): PAUL A. RODRIGUEZ DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/13/2006
Last Update Date: 03/15/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1821 NE 25TH STREET SUITE 100
LIGHTHOUSE POINT FL
33064
US

IV. Provider business mailing address

1821 NE 25TH STREET SUITE 100
LIGHTHOUSE POINT FL
33064
US

V. Phone/Fax

Practice location:
  • Phone: 954-941-0484
  • Fax: 954-941-0485
Mailing address:
  • Phone: 954-941-0484
  • Fax: 954-941-0485

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberOS7048
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License NumberOS7048
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: