Healthcare Provider Details

I. General information

NPI: 1669649521
Provider Name (Legal Business Name): VIMARIE RODRIGUEZ MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/09/2008
Last Update Date: 11/26/2024
Certification Date: 11/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7976 SEMINOLE BLVD STE 1
SEMINOLE FL
33772-4899
US

IV. Provider business mailing address

3251 N MCMULLEN BOOTH RD STE 303
CLEARWATER FL
33761-2022
US

V. Phone/Fax

Practice location:
  • Phone: 727-231-1800
  • Fax: 727-231-1801
Mailing address:
  • Phone: 727-725-6110
  • Fax: 727-669-9742

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number016250
License Number StatePR
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME154829
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number036119539
License Number StateIL
# 4
Primary TaxonomyN
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number092606
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: