Healthcare Provider Details

I. General information

NPI: 1710920434
Provider Name (Legal Business Name): VICENTE RODRIGUEZ M D P A
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/13/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12955 SW 42ND ST SUITE 12
MIAMI FL
33175-2902
US

IV. Provider business mailing address

PO BOX 650878
MIAMI FL
33265-0878
US

V. Phone/Fax

Practice location:
  • Phone: 305-383-6200
  • Fax: 305-383-6177
Mailing address:
  • Phone: 305-383-6200
  • Fax: 305-383-6177

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0805X
TaxonomyGeriatric Psychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. VICENTE RODRIGUEZ
Title or Position: PRESIDENT
Credential: M.D., M.B.A.
Phone: 305-383-6200