Healthcare Provider Details

I. General information

NPI: 1518354802
Provider Name (Legal Business Name): ZULAMY RODRIGUEZ PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/24/2015
Last Update Date: 04/24/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 SW 27TH AVE
MIAMI FL
33145-2546
US

IV. Provider business mailing address

6200 SW 122ND AVE
MIAMI FL
33183-1518
US

V. Phone/Fax

Practice location:
  • Phone: 305-461-2010
  • Fax:
Mailing address:
  • Phone: 786-355-4525
  • Fax: 305-273-8933

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA9108519
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: