Healthcare Provider Details

I. General information

NPI: 1871548313
Provider Name (Legal Business Name): CARMEN MILAGROS RODRIGUEZ RODRIGUEZ MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/23/2006
Last Update Date: 08/07/2024
Certification Date: 08/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7910 CITRUS GARDEN DR APT 102
TAMPA FL
33625-2464
US

IV. Provider business mailing address

7910 CITRUS GARDEN DR APT 102
TAMPA FL
33625-2464
US

V. Phone/Fax

Practice location:
  • Phone: 787-424-9038
  • Fax:
Mailing address:
  • Phone: 787-424-9038
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0805X
TaxonomyGeriatric Psychiatry Physician
License NumberME146992
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code2084P0805X
TaxonomyGeriatric Psychiatry Physician
License Number7744
License Number StatePR
# 3
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number1017942
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: