Provider Demographics
NPI:1235500653
Name:RODRIGUEZ-ROSA, ALAN FERNANDO (MD)
Entity Type:Individual
Prefix:
First Name:ALAN
Middle Name:FERNANDO
Last Name:RODRIGUEZ-ROSA
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:ENVISION PHYSICIAN
Mailing Address - Street 2:5380 TECH DATA DR SUITE 101
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33760
Mailing Address - Country:US
Mailing Address - Phone:787-221-4155
Mailing Address - Fax:
Practice Address - Street 1:5380 TECH DATA DR STE 101
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33760-3122
Practice Address - Country:US
Practice Address - Phone:787-221-4155
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-12
Last Update Date:2023-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101267417207R00000X
KY52444207R00000X
PR22113207R00000X
TN58251207R00000X
GA83533207R00000X
NY322247207R00000X
FLME140551207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine