Provider Demographics
NPI:1164096244
Name:GONZALEZ RODRIGUEZ, ROGELIO
Entity Type:Individual
Prefix:
First Name:ROGELIO
Middle Name:
Last Name:GONZALEZ RODRIGUEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23037 SW 108TH CT
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33170-7538
Mailing Address - Country:US
Mailing Address - Phone:786-728-1278
Mailing Address - Fax:
Practice Address - Street 1:9900 SW 107TH AVE STE 101
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33176-2798
Practice Address - Country:US
Practice Address - Phone:305-964-5381
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-13
Last Update Date:2021-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1800XAmbulatory Health Care FacilitiesClinic/CenterCorporate Health
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health