Provider Demographics
NPI:1093374183
Name:RODULFO, ALEJANDRO ENRIQUE (MD)
Entity Type:Individual
Prefix:
First Name:ALEJANDRO
Middle Name:ENRIQUE
Last Name:RODULFO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4560 SW 68TH COURT CIR APT 3
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33155-6818
Mailing Address - Country:US
Mailing Address - Phone:786-863-9103
Mailing Address - Fax:
Practice Address - Street 1:3501 JOHNSON ST
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021-5421
Practice Address - Country:US
Practice Address - Phone:954-844-1404
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-11
Last Update Date:2019-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLTRN29341OtherFLORIDA MEDICAL LICENSE: REGISTRATION FOR RESIDENT/HSE PHYSICIAN