Healthcare Provider Details

I. General information

NPI: 1447859475
Provider Name (Legal Business Name): MAURICIO RODRIGUEZ M.D/HOUSE PHYSICIAN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/21/2020
Last Update Date: 10/21/2020
Certification Date: 10/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9333 SW 152ND ST
PALMETTO BAY FL
33157-1778
US

IV. Provider business mailing address

8150 SW 72ND AVE APT 1825
MIAMI FL
33143-7767
US

V. Phone/Fax

Practice location:
  • Phone: 305-251-2500
  • Fax:
Mailing address:
  • Phone: 305-965-3202
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberHSE22454
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: