Provider Demographics
NPI:1457500258
Name:RODRIGUEZ, NISIS MARIE (MD)
Entity Type:Individual
Prefix:
First Name:NISIS
Middle Name:MARIE
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:NISIS
Other - Middle Name:M
Other - Last Name:RODRIGUEZ RAMOS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:6101 BLUE LAGOON DR STE 200
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33126-3168
Mailing Address - Country:US
Mailing Address - Phone:305-500-2000
Mailing Address - Fax:
Practice Address - Street 1:17160 ROYAL PALM BLVD STE 2
Practice Address - Street 2:
Practice Address - City:WESTON
Practice Address - State:FL
Practice Address - Zip Code:33326-2395
Practice Address - Country:US
Practice Address - Phone:954-762-6440
Practice Address - Fax:800-618-2120
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-17
Last Update Date:2024-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR18416207Q00000X, 207QG0300X
OH35.131606207QG0300X
FLME159275207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine