Healthcare Provider Details

I. General information

NPI: 1407788060
Provider Name (Legal Business Name): JUAN RODRIGUEZ HEALTH COACH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/29/2026
Last Update Date: 05/29/2026
Certification Date: 05/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

382 NE 191ST ST # 318890
MIAMI FL
33179-3899
US

IV. Provider business mailing address

382 NE 191ST ST # 318890
MIAMI FL
33179-3899
US

V. Phone/Fax

Practice location:
  • Phone: 863-777-1800
  • Fax:
Mailing address:
  • Phone: 863-777-1800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: