MEDICARE: RICARDO ANTONIO RODRIGUEZ PEREZ

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	390200000X	Student in an Organized Health Care Education/Training Program
2	207P00000X	Emergency Medicine Physician	ME155005	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	:	1710400353
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RICARDO ANTONIO RODRIGUEZ PEREZ

Provider Business Mailing Address
First Line	:	225 CALLE VIOLETA
Second Line	:	URB. SAN FRANCISCO
City	:	SAN JUAN
State	:	PR
Zip	:	00927
Country	:	US
Telephone Number	:	787-667-9920
Fax Number	:

Provider Business Practice Location Address
First Line	:	10145 NW 9TH STREET CIR APT 505
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33172-3279
Country	:	US
Telephone Number	:	787-667-9920
Fax Number	:

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

Provider Enumeration Date	:	07/25/2017
Last Update Date	:	06/09/2022

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Directions to “ RICARDO ANTONIO RODRIGUEZ PEREZ ” Practice Location

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