MEDICARE: YOMAYRA RODRIGUEZ MARIN MD

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	208D00000X	General Practice Physician	ACN831	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1205276953
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	YOMAYRA RODRIGUEZ MARIN MD

Provider Business Mailing Address
First Line	:	931 W OAK ST STE 103
Second Line	:
City	:	KISSIMMEE
State	:	FL
Zip	:	34741-4973
Country	:	US
Telephone Number	:	407-931-0444
Fax Number	:

Provider Business Practice Location Address
First Line	:	5425 S SEMORAN BLVD STE 7C
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32822-1777
Country	:	US
Telephone Number	:	407-931-0444
Fax Number	:	407-674-7887

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

Provider Enumeration Date	:	06/26/2013
Last Update Date	:	01/17/2025

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