Healthcare Provider Details

I. General information

NPI: 1750367611
Provider Name (Legal Business Name): RODOLFO F RODRIGUEZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/21/2005
Last Update Date: 03/10/2025
Certification Date: 03/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 E IRLO BRONSON MEMORIAL HWY
SAINT CLOUD FL
34769-4745
US

IV. Provider business mailing address

1000 E IRLO BRONSON MEMORIAL HWY
SAINT CLOUD FL
34769-4745
US

V. Phone/Fax

Practice location:
  • Phone: 407-564-3699
  • Fax: 407-593-9413
Mailing address:
  • Phone: 407-564-3699
  • Fax: 407-593-9413

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME91355
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: