Healthcare Provider Details

I. General information

NPI: 1639140320
Provider Name (Legal Business Name): SERGIO RODRIGUEZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/30/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7599 S DIXIE HWY
WEST PALM BEACH FL
33405-4813
US

IV. Provider business mailing address

7599 S DIXIE HIGHWAY
WEST PALM BEACH FL
33405
US

V. Phone/Fax

Practice location:
  • Phone: 561-585-6565
  • Fax: 561-585-5262
Mailing address:
  • Phone: 561-585-6565
  • Fax: 561-585-5262

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: