Provider Demographics
NPI:1427017441
Name:RODRIGUEZ, VANESSA (MD)
Entity Type:Individual
Prefix:
First Name:VANESSA
Middle Name:
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13660 JOG ROAD SUITE 2
Mailing Address - Street 2:
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33446-3806
Mailing Address - Country:US
Mailing Address - Phone:561-600-2408
Mailing Address - Fax:561-600-2414
Practice Address - Street 1:13660 S JOG RD STE 2
Practice Address - Street 2:
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33446-3806
Practice Address - Country:US
Practice Address - Phone:561-600-2408
Practice Address - Fax:561-600-2414
Is Sole Proprietor?:No
Enumeration Date:2006-03-20
Last Update Date:2018-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME100283207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL281264900Medicaid
FL7551553OtherAETNA PROVIDER NUMBER
FL11438184OtherCAQH NUMBER
FL281264900Medicaid
FLAK633ZMedicare PIN