Provider Demographics
NPI:1336101138
Name:RODRIGUEZ, LEANDRO I (MD)
Entity Type:Individual
Prefix:
First Name:LEANDRO
Middle Name:I
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 1:1577 ROBERTS DRIVE
Mailing Address - Street 2:SUITE #323
Mailing Address - City:JACKSONVILLE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32250
Mailing Address - Country:US
Mailing Address - Phone:904-241-9775
Mailing Address - Fax:904-249-3638
Practice Address - Street 1:1577 ROBERTS DRIVE
Practice Address - Street 2:SUITE #323
Practice Address - City:JACKSONVILLE BEACH
Practice Address - State:FL
Practice Address - Zip Code:32250
Practice Address - Country:US
Practice Address - Phone:904-241-9775
Practice Address - Fax:904-249-3638
Is Sole Proprietor?:No
Enumeration Date:2006-04-05
Last Update Date:2020-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME93617207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL273287400Medicaid
FL273287400Medicaid
FLI41718Medicare UPIN