Healthcare Provider Details

I. General information

NPI: 1699065904
Provider Name (Legal Business Name): CARLOS RODRIGUEZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/08/2011
Last Update Date: 09/22/2022
Certification Date: 09/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11750 SW 40TH STREET
MIAMI FL
33175
US

IV. Provider business mailing address

PO BOX 452317
SUNRISE FL
33345-2317
US

V. Phone/Fax

Practice location:
  • Phone: 305-223-3000
  • Fax:
Mailing address:
  • Phone: 954-838-2371
  • Fax: 954-851-1746

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberME122673
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: