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General NPI Number Information
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NPI Number | 1629356944
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Entity Type | Organization
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Legal Business Name | RODRIGUEZ MEDICAL GROUP, PA, INC.
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Dates
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Enumeration Date | 08/03/2011
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Last Update Date | 02/02/2012
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Provider Practice Location Address
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Address Line | 15190 SW 136TH STREET SUITE 15
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City | MIAMI
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State | FL
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Zip | 33196-2604
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Country | US
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Telephone | 305-964-7689
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Fax | 305-964-7989
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Provider Business Mailing Address
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Address Line | 15190 SW 136TH STREET SUITE 15
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City | MIAMI
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State | FL
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Zip | 33196-2604
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Country | US
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Telephone | 305-964-7689
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Fax | 305-964-7989
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Authorized Official
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Title or Position | PRESIDENT
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Name | MRS. INES RODRIGUEZ
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Credential | ARNP
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Telephone | 305-964-7689
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | ARNP9243349
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | ME104034
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License Number State | FL
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