Healthcare Provider Details
I. General information
NPI: 1235179706
Provider Name (Legal Business Name): GERMAINE RODRIGUEZ M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y
II. Dates (important events)
Enumeration Date: 06/06/2006
Last Update Date: 05/28/2019
Certification Date:
Deactivation Date:
Reactivation Date:
III. Provider practice location address
90 ALTON RD PH 33130
MIAMI BEACH FL
33139-6707
US
IV. Provider business mailing address
81 N HIBISCUS DR
MIAMI BEACH FL
33139-5117
US
V. Phone/Fax
- Phone: 305-532-4510
- Fax: 305-722-3625
- Phone: 786-553-4510
- Fax: 305-722-3625
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 2085R0202X |
| Taxonomy | Diagnostic Radiology Physician |
| License Number | ME70893 |
| License Number State | FL |
| # 2 | |
| Primary Taxonomy | N |
| Taxonomy Code | 2085B0100X |
| Taxonomy | Body Imaging Physician |
| License Number | ME70893 |
| License Number State | FL |
| # 3 | |
| Primary Taxonomy | N |
| Taxonomy Code | 2085U0001X |
| Taxonomy | Diagnostic Ultrasound Physician |
| License Number | ME70893 |
| License Number State | FL |
VIII. Authorized Official
Name:
Title or Position:
Credential:
Phone: