Healthcare Provider Details

I. General information

NPI: 1952532046
Provider Name (Legal Business Name): WILBERT DESS RODRIGUEZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/06/2009
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

810 N NOWELL ST
ORLANDO FL
32808-7539
US

IV. Provider business mailing address

121 S ORANGE AVE STE 940
ORLANDO FL
32801-3234
US

V. Phone/Fax

Practice location:
  • Phone: 407-290-9556
  • Fax: 407-290-9509
Mailing address:
  • Phone: 407-658-9687
  • Fax: 407-658-9688

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number17652
License Number StatePR
# 2
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberACN773
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: