Healthcare Provider Details

I. General information

NPI: 1457507923
Provider Name (Legal Business Name): LUIS IGNACIO RODRIGUEZ ALFONZO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: LUIS I RODRIGUEZ M.D.

II. Dates (important events)

Enumeration Date: 08/14/2008
Last Update Date: 08/22/2023
Certification Date: 08/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3100 SW 62ND AVE
MIAMI FL
33155-3009
US

IV. Provider business mailing address

3100 SW 62ND AVE
MIAMI FL
33155-3009
US

V. Phone/Fax

Practice location:
  • Phone: 800-432-6837
  • Fax:
Mailing address:
  • Phone: 786-624-3415
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberME 108911
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207LP3000X
TaxonomyPediatric Anesthesiology Physician
License NumberME108911
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: