Healthcare Provider Details

I. General information

NPI: 1043458326
Provider Name (Legal Business Name): ROGELIO OSCAR BARDINAS RODRIGUEZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/26/2009
Last Update Date: 11/14/2025
Certification Date: 11/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14255 SW 42ND ST UNIT 13-A
MIAMI FL
33175-6408
US

IV. Provider business mailing address

3148 SW 143RD PL
MIAMI FL
33175-7435
US

V. Phone/Fax

Practice location:
  • Phone: 305-306-3400
  • Fax: 305-402-2800
Mailing address:
  • Phone: 786-201-1548
  • Fax: 305-441-9702

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME106246
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: