Provider Demographics
NPI:1306003413
Name:RODRIGUEZ FERNANDEZ, BORIS (CRNA)
Entity Type:Individual
Prefix:
First Name:BORIS
Middle Name:
Last Name:RODRIGUEZ FERNANDEZ
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11031 NE 6TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33161-7182
Mailing Address - Country:US
Mailing Address - Phone:305-398-6100
Mailing Address - Fax:305-757-4465
Practice Address - Street 1:17567 S DIXIE HWY
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33157-5435
Practice Address - Country:US
Practice Address - Phone:786-293-9544
Practice Address - Fax:786-293-9594
Is Sole Proprietor?:No
Enumeration Date:2008-05-19
Last Update Date:2019-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN9361023367500000X
104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No104100000XBehavioral Health & Social Service ProvidersSocial Worker