Healthcare Provider Details

I. General information

NPI: 1972446094
Provider Name (Legal Business Name): SERGIO ALEXANDER RODRIGUEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/13/2026
Last Update Date: 04/13/2026
Certification Date: 04/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16853 NE 2ND AVE STE 102
NORTH MIAMI BEACH FL
33162-1776
US

IV. Provider business mailing address

9431 LIVE OAK PL APT 407
DAVIE FL
33324-4737
US

V. Phone/Fax

Practice location:
  • Phone: 954-262-4100
  • Fax:
Mailing address:
  • Phone: 786-368-0544
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: