Provider Demographics
NPI:1447611827
Name:RODRIGUEZ, ORIALYS (PHYSICIAN ASSISTANT)
Entity Type:Individual
Prefix:
First Name:ORIALYS
Middle Name:
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1675 MARKET ST STE 203
Mailing Address - Street 2:
Mailing Address - City:WESTON
Mailing Address - State:FL
Mailing Address - Zip Code:33326-3681
Mailing Address - Country:US
Mailing Address - Phone:954-369-1981
Mailing Address - Fax:
Practice Address - Street 1:1675 MARKET ST STE 203
Practice Address - Street 2:
Practice Address - City:WESTON
Practice Address - State:FL
Practice Address - Zip Code:33326-3681
Practice Address - Country:US
Practice Address - Phone:786-307-3865
Practice Address - Fax:954-688-7055
Is Sole Proprietor?:No
Enumeration Date:2016-03-14
Last Update Date:2021-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9109300363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical