=====================================================
General NPI Number Information
=====================================================
NPI Number | 1982116877
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CARLOS RODRIGUEZ ORTIZ MD, PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/31/2017
-----------------------------------------------------
Last Update Date | 10/31/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 705 E 26TH ST
-----------------------------------------------------
City | HIALEAH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33013-3823
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 786-332-2922
-----------------------------------------------------
Fax | 786-332-2956
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 705 E 26TH ST
-----------------------------------------------------
City | HIALEAH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33013-3823
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 786-332-2922
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT/PHYSICIAN
-----------------------------------------------------
Name | DR. CARLOS ALBERTO RODRIGUEZ
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 786-326-4558
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207V00000X
-----------------------------------------------------
Taxonomy Name | Obstetrics & Gynecology Physician
-----------------------------------------------------
License Number | ME124265
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------