MEDICARE: IDALMIS C. RODRIGUEZ BA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	104100000X	Social Worker

General Provider Information

NPI Number	:	1174826622
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	IDALMIS C. RODRIGUEZ BA

Provider Business Mailing Address
First Line	:	5600 SW 135TH AVE
Second Line	:	STE 207
City	:	MIAMI
State	:	FL
Zip	:	33183-5101
Country	:	US
Telephone Number	:	786-216-9484
Fax Number	:	305-603-7955

Provider Business Practice Location Address
First Line	:	5600 SW 135TH AVE
Second Line	:	STE 207
City	:	MIAMI
State	:	FL
Zip	:	33183-5101
Country	:	US
Telephone Number	:	786-216-9484
Fax Number	:	305-603-7955

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/06/2010
Last Update Date	:	08/17/2021

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