Healthcare Provider Details

I. General information

NPI: 1639358849
Provider Name (Legal Business Name): ANA M RODRIGUEZ PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/24/2007
Last Update Date: 03/12/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10860 SW 88TH ST SUITE 1
MIAMI FL
33176-2680
US

IV. Provider business mailing address

10860 SW 88TH ST SUITE 1
MIAMI FL
33176-2680
US

V. Phone/Fax

Practice location:
  • Phone: 305-595-1300
  • Fax: 305-275-8988
Mailing address:
  • Phone: 305-595-1300
  • Fax: 305-275-8988

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9104787
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: