Healthcare Provider Details

I. General information

NPI: 1396492054
Provider Name (Legal Business Name): GILBERTO RODRIGUEZ MEDICAL SERVICES AND CONSULTANT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/03/2022
Last Update Date: 03/03/2022
Certification Date: 03/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8758 NW 141ST TER
MIAMI LAKES FL
33018-7352
US

IV. Provider business mailing address

8758 NW 141ST TER
MIAMI LAKES FL
33018-7352
US

V. Phone/Fax

Practice location:
  • Phone: 305-923-2562
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: GILBERTO RODRIGUEZ
Title or Position: CEO
Credential: PA-C
Phone: 305-923-2562