Provider Demographics
NPI:1417194929
Name:RODRIGUEZ, MANUEL BERNARDO SR (MD)
Entity Type:Individual
Prefix:DR
First Name:MANUEL
Middle Name:BERNARDO
Last Name:RODRIGUEZ
Suffix:SR
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 1:410 NE 52ND ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33137-3031
Mailing Address - Country:US
Mailing Address - Phone:305-756-6644
Mailing Address - Fax:305-751-0945
Practice Address - Street 1:410 NE 52ND ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33137-3031
Practice Address - Country:US
Practice Address - Phone:305-756-6644
Practice Address - Fax:305-751-0945
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-21
Last Update Date:2009-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0020936207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL068516000Medicaid
FL068516000Medicaid