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General NPI Number Information
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NPI Number | 1194803379
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Entity Type | Organization
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Legal Business Name | SERGIO M RODRIGUEZ JR MD PA
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Dates
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Enumeration Date | 11/02/2006
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Last Update Date | 09/27/2011
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Provider Practice Location Address
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Address Line | 777 EAST 25 STREET SUITE 210
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City | HIALEAH
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State | FL
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Zip | 33013
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Country | US
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Telephone | 305-691-3505
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Fax | 305-691-4104
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Provider Business Mailing Address
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Address Line | 777 EAST 25 STREET SUITE 210
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City | HIALEAH
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State | FL
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Zip | 33013
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Country | US
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Telephone | 305-691-3505
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Fax | 305-691-4104
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Authorized Official
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Title or Position | OWNER PRESIDENT
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Name | MR. SERGIO M RODRIGUEZ JR.
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Credential | MD
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Telephone | 305-691-3505
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | ME0058313
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License Number State | FL
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