Healthcare Provider Details

I. General information

NPI: 1699741470
Provider Name (Legal Business Name): VICTOR E RODRIGUEZ-VIERA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/23/2006
Last Update Date: 05/23/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1820 43RD AVE SUITE 2
VERO BEACH FL
32960-0574
US

IV. Provider business mailing address

1820 43RD AVE SUITE 2
VERO BEACH FL
32960-0574
US

V. Phone/Fax

Practice location:
  • Phone: 772-562-1204
  • Fax:
Mailing address:
  • Phone: 772-562-1204
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberME0020943
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: