Healthcare Provider Details

I. General information

NPI: 1609388784
Provider Name (Legal Business Name): DIEGO F RODRIGUEZ CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/30/2017
Last Update Date: 01/18/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13334 SW 111TH TER
MIAMI FL
33186-4349
US

IV. Provider business mailing address

13334 SW 111TH TER
MIAMI FL
33186-4349
US

V. Phone/Fax

Practice location:
  • Phone: 305-878-5148
  • Fax:
Mailing address:
  • Phone: 305-878-5148
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN9320955
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberARNP9320955
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: