Healthcare Provider Details

I. General information

NPI: 1760643019
Provider Name (Legal Business Name): ALICIA RODRIGUEZ -JORGE M D P A
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/19/2008
Last Update Date: 07/21/2025
Certification Date: 07/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3185 SW 8TH ST
MIAMI FL
33135-4533
US

IV. Provider business mailing address

3185 SW 8TH ST
MIAMI FL
33135-4533
US

V. Phone/Fax

Practice location:
  • Phone: 305-859-7719
  • Fax:
Mailing address:
  • Phone: 305-859-7719
  • Fax: 305-859-7839

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number78063
License Number StateFL

VIII. Authorized Official

Name: ALICIA RODRIGUEZ -JORGE
Title or Position: OWNER
Credential:
Phone: 305-859-7719