Healthcare Provider Details

I. General information

NPI: 1154702280
Provider Name (Legal Business Name): ALICIA RODRIGUEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/15/2015
Last Update Date: 06/15/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5870 SW 8TH ST STE 3
WEST MIAMI FL
33144-5052
US

IV. Provider business mailing address

5870 SW 8TH ST STE 3
WEST MIAMI FL
33144-5052
US

V. Phone/Fax

Practice location:
  • Phone: 305-444-3025
  • Fax: 305-444-3141
Mailing address:
  • Phone: 305-444-3025
  • Fax: 305-444-3141

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License NumberRPT53406
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: