Provider Demographics
NPI:1619294550
Name:CARLOS O. RODRIGUEZ, M.D., P.A.
Entity Type:Organization
Organization Name:CARLOS O. RODRIGUEZ, M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CARLOS
Authorized Official - Middle Name:ORESTES
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-858-2424
Mailing Address - Street 1:1933 SW 27TH AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33145-2538
Mailing Address - Country:US
Mailing Address - Phone:305-858-2424
Mailing Address - Fax:305-858-2445
Practice Address - Street 1:1933 SW 27TH AVE STE 101
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33145-2538
Practice Address - Country:US
Practice Address - Phone:305-858-2424
Practice Address - Fax:305-858-2445
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-03
Last Update Date:2011-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME81643208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL259017400Medicaid
FLEF024AOtherMEDICARE PTAN