Provider Demographics
NPI:1093864548
Name:RODRIGUEZ, CARLOS O (MD)
Entity Type:Individual
Prefix:
First Name:CARLOS
Middle Name:O
Last Name:RODRIGUEZ
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 1:1933 SW 27TH AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33145-2538
Mailing Address - Country:US
Mailing Address - Phone:305-858-2424
Mailing Address - Fax:305-858-2445
Practice Address - Street 1:1933 SW 27TH AVE STE 101
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33145-2538
Practice Address - Country:US
Practice Address - Phone:305-858-2424
Practice Address - Fax:305-858-2445
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-10
Last Update Date:2023-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME81643208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL259017400Medicaid
FLH31343Medicare UPIN
FLE5075YMedicare PIN