Healthcare Provider Details

I. General information

NPI: 1699134775
Provider Name (Legal Business Name): JUAN PABLO RODRIGUEZ-ESCUDERO M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/17/2016
Last Update Date: 08/31/2020
Certification Date: 08/31/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4300 ALTON RD
MIAMI BEACH FL
33140-2948
US

IV. Provider business mailing address

540 BRICKELL KEY DR APT 506
MIAMI FL
33131
US

V. Phone/Fax

Practice location:
  • Phone: 305-224-8120
  • Fax:
Mailing address:
  • Phone: 507-269-9131
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberTRN#18627
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberMED-PHYS-LIC-84628
License Number StateMT
# 3
Primary TaxonomyY
Taxonomy Code207RA0001X
TaxonomyAdvanced Heart Failure and Transplant Cardiology Physician
License NumberMED-PHYS-LIC-84628
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: