Provider Demographics
NPI:1578576179
Name:RODRIGUEZ, ROSANA (DPM)
Entity Type:Individual
Prefix:DR
First Name:ROSANA
Middle Name:
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 SAINT JOHNS MEDICAL PARK DR
Mailing Address - Street 2:
Mailing Address - City:SAINT AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32086-5298
Mailing Address - Country:US
Mailing Address - Phone:904-823-3301
Mailing Address - Fax:904-823-3328
Practice Address - Street 1:6 SAINT JOHNS MEDICAL PARK DR
Practice Address - Street 2:
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32086-4233
Practice Address - Country:US
Practice Address - Phone:904-823-3301
Practice Address - Fax:904-823-3328
Is Sole Proprietor?:No
Enumeration Date:2006-08-14
Last Update Date:2015-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO2734213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
480027595OtherRR MEDICARE
FLP02734OtherSTATE LICENSE
65581AMedicare ID - Type Unspecified
480027595OtherRR MEDICARE
U71756Medicare UPIN