Provider Demographics
NPI:1265633903
Name:RODRIGUEZ, ANGELA MARIA (MD)
Entity Type:Individual
Prefix:DR
First Name:ANGELA
Middle Name:MARIA
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 11892
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33339-1892
Mailing Address - Country:US
Mailing Address - Phone:954-542-5832
Mailing Address - Fax:954-351-1571
Practice Address - Street 1:1330 RIVERLAND RD
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33312-2961
Practice Address - Country:US
Practice Address - Phone:954-321-9826
Practice Address - Fax:954-321-9660
Is Sole Proprietor?:No
Enumeration Date:2007-05-30
Last Update Date:2019-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME103196207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL001449400Medicaid
FLP00769977OtherRAILROAD MEDICARE
FLCB919ZMedicare PIN