Provider Demographics
NPI:1598973091
Name:RAQUEL RODRIGUEZ
Entity Type:Organization
Organization Name:RAQUEL RODRIGUEZ
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:EILEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:FERMIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:772-589-0300
Mailing Address - Street 1:13230 US HIGHWAY 1
Mailing Address - Street 2:
Mailing Address - City:SEBASTIAN
Mailing Address - State:FL
Mailing Address - Zip Code:32958-3748
Mailing Address - Country:US
Mailing Address - Phone:772-589-0300
Mailing Address - Fax:772-589-4550
Practice Address - Street 1:13230 US HIGHWAY 1
Practice Address - Street 2:
Practice Address - City:SEBASTIAN
Practice Address - State:FL
Practice Address - Zip Code:32958-3748
Practice Address - Country:US
Practice Address - Phone:772-589-0300
Practice Address - Fax:772-589-4550
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-18
Last Update Date:2016-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLA1336Medicare PIN