Healthcare Provider Details

I. General information

NPI: 1639006232
Provider Name (Legal Business Name): KENIA MARIA RODRIGUEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/06/2026
Last Update Date: 05/06/2026
Certification Date: 05/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7031 SW 62ND AVE
SOUTH MIAMI FL
33143-4701
US

IV. Provider business mailing address

10451 SW 17TH ST
MIAMI FL
33165-7369
US

V. Phone/Fax

Practice location:
  • Phone: 305-284-7761
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License NumberDH-32986
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: