Healthcare Provider Details

I. General information

NPI: 1215700380
Provider Name (Legal Business Name): RAFAEL E RODRIGUEZ OCASIO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/01/2023
Last Update Date: 09/12/2025
Certification Date: 09/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3100 17TH ST STE A
SAINT CLOUD FL
34769-6021
US

IV. Provider business mailing address

3100 17TH ST STE A
SAINT CLOUD FL
34769-6021
US

V. Phone/Fax

Practice location:
  • Phone: 727-322-3439
  • Fax: 800-928-7449
Mailing address:
  • Phone: 407-892-0009
  • Fax: 407-892-3285

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number24198
License Number StatePR
# 2
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberACN1698
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: