MEDICARE: JORGE ALEJANDRO GAINZA RODRIGUEZ PMHNP-BC

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	APRN11034833	FL

General Provider Information

NPI Number	:	1518460179
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JORGE ALEJANDRO GAINZA RODRIGUEZ PMHNP-BC

Provider Business Mailing Address
First Line	:	11850 SW 175TH TER
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33177-2259
Country	:	US
Telephone Number	:	305-399-6370
Fax Number	:

Provider Business Practice Location Address
First Line	:	11850 SW 175TH TER
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33177-2259
Country	:	US
Telephone Number	:	305-399-6370
Fax Number	:

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

Provider Enumeration Date	:	03/09/2018
Last Update Date	:	11/16/2025

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