Provider Demographics
NPI:1134325004
Name:RODRIGUEZ-VILLANUEVA, BETZAIDA (MD)
Entity Type:Individual
Prefix:DR
First Name:BETZAIDA
Middle Name:
Last Name:RODRIGUEZ-VILLANUEVA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1921 WALDEMERE ST
Mailing Address - Street 2:SUITE 413
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34239-2943
Mailing Address - Country:US
Mailing Address - Phone:941-917-6585
Mailing Address - Fax:941-917-6514
Practice Address - Street 1:1921 WALDEMERE ST
Practice Address - Street 2:SUITE 413
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34239-2943
Practice Address - Country:US
Practice Address - Phone:941-917-6585
Practice Address - Fax:941-917-6514
Is Sole Proprietor?:No
Enumeration Date:2007-06-26
Last Update Date:2016-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME123162207RN0300X
MS23302208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL015872600Medicaid
FLII884ZMedicare PIN