=====================================================
General NPI Number Information
=====================================================
NPI Number | 1821290339
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DAVID RODRIGUEZ MD PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/05/2007
-----------------------------------------------------
Last Update Date | 04/29/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7400 N KENDALL DR 313
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33156-7721
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-670-0260
-----------------------------------------------------
Fax | 305-670-2665
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7400 N KENDALL DR 313
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33156-7721
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-670-0260
-----------------------------------------------------
Fax | 305-670-2665
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. DAVID A RODRIGUEZ
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 305-670-0260
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207N00000X
-----------------------------------------------------
Taxonomy Name | Dermatology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------