Provider Demographics
NPI:1558614784
Name:RODRIGUEZ, SUZZETTE MARIE (RD, LD/N)
Entity Type:Individual
Prefix:MISS
First Name:SUZZETTE
Middle Name:MARIE
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:RD, LD/N
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1611 NW 12TH AVENUE
Mailing Address - Street 2:JACKSON MEMORIAL HOSPITAL
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33136-1096
Mailing Address - Country:US
Mailing Address - Phone:305-585-7330
Mailing Address - Fax:
Practice Address - Street 1:1611 NORTH WEST AVENUE
Practice Address - Street 2:JACKSON MEMORIAL HOSPITAL
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33136-1096
Practice Address - Country:US
Practice Address - Phone:305-585-2255
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-25
Last Update Date:2012-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND5925133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered