Provider Demographics
NPI:1548772650
Name:RODRIGUEZ, ELENA HERSCHDORFER (DO)
Entity Type:Individual
Prefix:DR
First Name:ELENA
Middle Name:HERSCHDORFER
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 494606
Mailing Address - Street 2:
Mailing Address - City:PORT CHARLOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:33949-4606
Mailing Address - Country:US
Mailing Address - Phone:786-316-3649
Mailing Address - Fax:
Practice Address - Street 1:713 E MARION AVE STE 131
Practice Address - Street 2:
Practice Address - City:PUNTA GORDA
Practice Address - State:FL
Practice Address - Zip Code:33950-3868
Practice Address - Country:US
Practice Address - Phone:941-575-1514
Practice Address - Fax:941-639-0466
Is Sole Proprietor?:No
Enumeration Date:2017-10-30
Last Update Date:2020-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLU04643207Q00000X
FLOS15077207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine