Provider Demographics
NPI:1235279076
Name:LEUNAM RODRIGUEZ MD PA
Entity Type:Organization
Organization Name:LEUNAM RODRIGUEZ MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LEUNAM
Authorized Official - Middle Name:J
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-663-0088
Mailing Address - Street 1:1150 CAMPO SANO AVE
Mailing Address - Street 2:SUITE 420
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33146-1174
Mailing Address - Country:US
Mailing Address - Phone:305-663-0088
Mailing Address - Fax:305-663-1933
Practice Address - Street 1:1150 CAMPO SANO AVE
Practice Address - Street 2:SUITE 420
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33146-1174
Practice Address - Country:US
Practice Address - Phone:305-663-0088
Practice Address - Fax:305-663-1933
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-08
Last Update Date:2009-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME93811261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLI45090Medicare UPIN
FLK8852Medicare PIN