MEDICARE: PREVENTIVE HEALTH INC

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	207R00000X	Internal Medicine Physician	ME106903	FL

General Provider Information

NPI Number	:	1912262791
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PREVENTIVE HEALTH INC

Provider Business Mailing Address
First Line	:	8040 NW 95TH ST
Second Line	:	SUITE 331-332
City	:	HIALEAH GARDENS
State	:	FL
Zip	:	33016-2362
Country	:	US
Telephone Number	:	305-819-1110
Fax Number	:

Provider Business Practice Location Address
First Line	:	8040 NW 95TH ST
Second Line	:	SUITE 331-332
City	:	HIALEAH GARDENS
State	:	FL
Zip	:	33016-2362
Country	:	US
Telephone Number	:	305-819-1110
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. CARLOS LORENZO RODRIGUEZ
Credential	:	MD
Telephone Number	:	305-819-1110

Provider Enumeration Date	:	07/09/2012
Last Update Date	:	07/09/2012

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