Provider Demographics
NPI:1598104986
Name:1055 WASHINGTON AVENUE, INC
Entity Type:Organization
Organization Name:1055 WASHINGTON AVENUE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:J.R.
Authorized Official - Middle Name:
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-534-9009
Mailing Address - Street 1:1055 WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33139-5017
Mailing Address - Country:US
Mailing Address - Phone:305-534-9009
Mailing Address - Fax:305-532-5942
Practice Address - Street 1:1055 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33139-5017
Practice Address - Country:US
Practice Address - Phone:305-534-9009
Practice Address - Fax:305-532-5942
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-18
Last Update Date:2013-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH10107111N00000X
FLME50089207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty