Healthcare Provider Details

I. General information

NPI: 1437866068
Provider Name (Legal Business Name): JOSE CARLOS BUENO RODRIGUEZ SR. APRN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/02/2022
Last Update Date: 11/03/2022
Certification Date: 11/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11400 SW 18TH CT
MIRAMAR FL
33025-6612
US

IV. Provider business mailing address

11400 SW 18TH CT
MIRAMAR FL
33025-6612
US

V. Phone/Fax

Practice location:
  • Phone: 915-305-0802
  • Fax:
Mailing address:
  • Phone: 915-305-0802
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11022595
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: