Healthcare Provider Details

I. General information

NPI: 1558314468
Provider Name (Legal Business Name): RODOLFO SIDRON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/19/2006
Last Update Date: 09/20/2022
Certification Date: 09/20/2022
Deactivation Date: 07/17/2006
Reactivation Date: 10/11/2006

III. Provider practice location address

8410 W FLAGLER ST STE 212-213
MIAMI FL
33144-2092
US

IV. Provider business mailing address

8410 W FLAGLER ST STE 212-213
MIAMI FL
33144-2092
US

V. Phone/Fax

Practice location:
  • Phone: 786-388-9877
  • Fax: 786-388-9627
Mailing address:
  • Phone: 786-388-9877
  • Fax: 786-388-9627

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD87379
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME87379
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: