=====================================================
General NPI Number Information
=====================================================
NPI Number | 1972504579
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LEUNAM JESYS RODRIGUEZ MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/03/2005
-----------------------------------------------------
Last Update Date | 11/05/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5000 UNIVERSITY DR STE 1100
-----------------------------------------------------
City | CORAL GABLES
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33146-2008
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-663-0088
-----------------------------------------------------
Fax | 305-663-1933
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5000 UNIVERSITY DR STE 1100
-----------------------------------------------------
City | CORAL GABLES
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33146-2008
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-663-0088
-----------------------------------------------------
Fax | 305-663-1933
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | ME93811
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------