Provider Demographics
NPI:1124385778
Name:MAURO RODRIGUEZ, M.D.
Entity Type:Organization
Organization Name:MAURO RODRIGUEZ, M.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:MAURO
Authorized Official - Middle Name:
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:727-600-8090
Mailing Address - Street 1:611 DRUID RD E STE 506
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33756-3938
Mailing Address - Country:US
Mailing Address - Phone:727-600-8090
Mailing Address - Fax:727-600-8088
Practice Address - Street 1:611 DRUID RD E STE 506
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33756-3938
Practice Address - Country:US
Practice Address - Phone:727-600-8090
Practice Address - Fax:727-600-8088
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-20
Last Update Date:2012-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME00248912084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL057718900Medicaid
FL52915OtherBLUE CROSS & BLUE SHIELD OF FLORIDA
FL52915ZMedicare PIN