Healthcare Provider Details

I. General information

NPI: 1679898332
Provider Name (Legal Business Name): CARLOS F RODRIGUEZ M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2010
Last Update Date: 03/01/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5350 UNIVERSITY PKWY SUITE 101
SARASOTA FL
34243-5812
US

IV. Provider business mailing address

PO BOX 863407
ORLANDO FL
32886-3407
US

V. Phone/Fax

Practice location:
  • Phone: 941-917-4675
  • Fax: 941-917-4688
Mailing address:
  • Phone: 941-917-2600
  • Fax: 941-917-7884

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberE-7251
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: