Provider Demographics
NPI:1588635726
Name:RODRIGUEZ, CRISTINA B (MD)
Entity Type:Individual
Prefix:
First Name:CRISTINA
Middle Name:B
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4990 KEOHONE DR
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32309-2749
Mailing Address - Country:US
Mailing Address - Phone:850-893-5709
Mailing Address - Fax:
Practice Address - Street 1:2416 E PLAZA DR
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-5301
Practice Address - Country:US
Practice Address - Phone:850-877-7123
Practice Address - Fax:850-878-7036
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME66198208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLF83690Medicare UPIN