Healthcare Provider Details

I. General information

NPI: 1891007316
Provider Name (Legal Business Name): KELLIE MICHELLE RODRIGUEZ CDE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2010
Last Update Date: 12/07/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1450 NW 10TH AVE
MIAMI FL
33136-1011
US

IV. Provider business mailing address

1500 NW 12TH AVE STE 1007
MIAMI FL
33136-1046
US

V. Phone/Fax

Practice location:
  • Phone: 305-243-4090
  • Fax: 305-243-5791
Mailing address:
  • Phone: 305-243-4664
  • Fax: 305-243-9927

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WD0400X
TaxonomyDiabetes Educator Registered Nurse
License NumberRN 9244645
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: