MEDICARE: HECTOR S RODRIGUEZ M.D.

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	ME66905	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	25957	OTHER	FL	BLUE CROSS

General Provider Information

NPI Number	:	1336172162
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HECTOR S RODRIGUEZ M.D.

Provider Business Mailing Address
First Line	:	4011 W FLAGLER STREET
Second Line	:	SUITE 204
City	:	MIAMI
State	:	FL
Zip	:	33134-1643
Country	:	US
Telephone Number	:	305-774-1234
Fax Number	:	305-774-1639

Provider Business Practice Location Address
First Line	:	4201 PALM AVE
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33012-4424
Country	:	US
Telephone Number	:	855-226-6633
Fax Number	:

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

Provider Enumeration Date	:	07/07/2006
Last Update Date	:	04/27/2020

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