Provider Demographics
NPI:1588191449
Name:RODRIGUEZ AVILA, ULISES LAZARO (MD)
Entity Type:Individual
Prefix:DR
First Name:ULISES
Middle Name:LAZARO
Last Name:RODRIGUEZ AVILA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:6100 BLUE LAGOON DR STE 365
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33126-7010
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:321 OPA LOCKA BLVD
Practice Address - Street 2:
Practice Address - City:OPA LOCKA
Practice Address - State:FL
Practice Address - Zip Code:33054-3526
Practice Address - Country:US
Practice Address - Phone:786-476-3333
Practice Address - Fax:786-621-7816
Is Sole Proprietor?:No
Enumeration Date:2017-05-22
Last Update Date:2021-03-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLACN1009208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice