Healthcare Provider Details

I. General information

NPI: 1982713541
Provider Name (Legal Business Name): JOSE J RODRIGUEZ MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/29/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5703 NW 7 STREET
MIAMI FL
33126-3105
US

IV. Provider business mailing address

5703 NW 7 STREET
MIAMI FL
33126-3105
US

V. Phone/Fax

Practice location:
  • Phone: 305-266-2621
  • Fax: 305-266-2671
Mailing address:
  • Phone: 305-266-2621
  • Fax: 305-266-2671

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number82753
License Number StateFL

VIII. Authorized Official

Name: JOSE JOAQUIN RODRIGUEZ
Title or Position: PRESIDENT OWNER MD
Credential: MD
Phone: 305-266-2321