Healthcare Provider Details

I. General information

NPI: 1699218024
Provider Name (Legal Business Name): LEONARDO RODRIGUEZ PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/03/2016
Last Update Date: 10/20/2022
Certification Date: 10/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1321 NW 14TH ST STE 202
MIAMI FL
33125-1653
US

IV. Provider business mailing address

1321 NW 14 STREET SUITE 202
MIAMI FL
33125-2918
US

V. Phone/Fax

Practice location:
  • Phone: 305-324-0220
  • Fax: 305-545-0790
Mailing address:
  • Phone: 305-324-0220
  • Fax: 305-545-0790

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA9110038
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberPA9110038
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9110038
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: