Provider Demographics
NPI:1376949917
Name:RODRIGUEZ, EVELIO
Entity Type:Individual
Prefix:
First Name:EVELIO
Middle Name:
Last Name:RODRIGUEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15096 SW 20THLANE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33185
Mailing Address - Country:US
Mailing Address - Phone:786-246-1161
Mailing Address - Fax:
Practice Address - Street 1:20595 OLD CUTLER RD
Practice Address - Street 2:
Practice Address - City:CUTLER BAY
Practice Address - State:FL
Practice Address - Zip Code:33189-2456
Practice Address - Country:US
Practice Address - Phone:305-823-3312
Practice Address - Fax:305-884-3989
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-10
Last Update Date:2015-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9245612261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center