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General NPI Number Information
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NPI Number | 1235775883
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Entity Type | Organization
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Legal Business Name | IVAN R RODRIGUEZ MD PA
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Dates
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Enumeration Date | 11/19/2019
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Last Update Date | 01/30/2023
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Provider Practice Location Address
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Address Line | 12002 SW 128TH CT STE 204
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City | MIAMI
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State | FL
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Zip | 33186-4643
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Country | US
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Telephone | 305-234-8264
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Fax | 305-255-1752
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Provider Business Mailing Address
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Address Line | 12002 SW 128TH CT STE 204
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City | MIAMI
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State | FL
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Zip | 33186-4643
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Country | US
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Telephone | 305-234-8264
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Fax | 305-255-1752
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Authorized Official
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Title or Position | OWNER/PRESIDENT
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Name | DR. IVAN R RODRIGUEZ
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Credential | M.D.
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Telephone | 305-234-8264
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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