MEDICARE: DR. MARIA C RODRIGUEZ PHD

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	103TC0700X	Clinical Psychologist	PY0004566	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	28145	OTHER	FL	HEALTH EASE PROVIDER ID
2	080182	OTHER	FL	VALUE OPTIONS MHS NUMBER
3	084496	OTHER	FL	MHN PROVIDER NUMBER
4	208564	OTHER	FL	AV MED PROVIDER ID
5	10680	OTHER	FL	DIMENSION HEALTH PROVIDER
6	9047512	OTHER	FL	PHES PJD NUMBER

General Provider Information

NPI Number	:	1457461196
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARIA C RODRIGUEZ PHD

Provider Business Mailing Address
First Line	:	6625 MIAMI LAKES DR
Second Line	:	SUITE 377
City	:	MIAMI LAKES
State	:	FL
Zip	:	33014-2708
Country	:	US
Telephone Number	:	305-779-8593
Fax Number	:	305-779-8598

Provider Business Practice Location Address
First Line	:	6625 MIAMI LAKES DR
Second Line	:	SUITE 377
City	:	MIAMI LAKES
State	:	FL
Zip	:	33014-2708
Country	:	US
Telephone Number	:	305-779-8593
Fax Number	:	305-779-8598

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

Provider Enumeration Date	:	08/30/2006
Last Update Date	:	12/31/2010

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Directions to “ DR. MARIA C RODRIGUEZ PHD” Practice Location

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