Healthcare Provider Details

I. General information

NPI: 1699187583
Provider Name (Legal Business Name): ORLANDO RODRIGUEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2014
Last Update Date: 05/27/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14736 N KENDALL DR
MIAMI FL
33196-1481
US

IV. Provider business mailing address

13700 SW 62ND ST APT 206
MIAMI FL
33183-2005
US

V. Phone/Fax

Practice location:
  • Phone: 305-387-3300
  • Fax:
Mailing address:
  • Phone: 786-417-4044
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247200000X
TaxonomyOther Technician
License Number1717403
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: