Provider Demographics
NPI:1053840496
Name:RODRIGUEZ, VERONICA
Entity Type:Individual
Prefix:
First Name:VERONICA
Middle Name:
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1809 SW 23RD ST
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33315-1846
Mailing Address - Country:US
Mailing Address - Phone:954-793-1260
Mailing Address - Fax:
Practice Address - Street 1:1809 SW 23RD ST
Practice Address - Street 2:
Practice Address - City:FORT. LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33315
Practice Address - Country:US
Practice Address - Phone:954-793-1260
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-08
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL233930376J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL020637000Medicaid