Provider Demographics
NPI:1285021816
Name:RODRIGUEZ, ANDRES LUIS (MD)
Entity Type:Individual
Prefix:DR
First Name:ANDRES
Middle Name:LUIS
Last Name:RODRIGUEZ
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 1:800 SW 108TH AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33174-2555
Mailing Address - Country:US
Mailing Address - Phone:305-348-3627
Mailing Address - Fax:305-348-4261
Practice Address - Street 1:800 SW 108TH AVE STE 100
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33174
Practice Address - Country:US
Practice Address - Phone:305-348-3627
Practice Address - Fax:305-348-4261
Is Sole Proprietor?:No
Enumeration Date:2015-04-21
Last Update Date:2018-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME129945207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLME129945OtherMEDICAL LICENSE