Healthcare Provider Details

I. General information

NPI: 1043430895
Provider Name (Legal Business Name): JUAN ENRIQUE RODRIGUEZ, M.D., P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/26/2007
Last Update Date: 07/07/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9480 SW 77TH AVE
MIAMI FL
33156-7903
US

IV. Provider business mailing address

9480 SW 77TH AVE
MIAMI FL
33156-7903
US

V. Phone/Fax

Practice location:
  • Phone: 305-595-6695
  • Fax:
Mailing address:
  • Phone: 305-595-6695
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code102L00000X
TaxonomyPsychoanalyst
License NumberME13770
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberME13770
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberME13770
License Number StateFL

VIII. Authorized Official

Name: JUAN ENRIQUES RODRIGUEZ
Title or Position: PRESIDENT
Credential: M.D.
Phone: 305-595-6695