Provider Demographics
NPI:1619913878
Name:IGLESIAS, ROGELIO (MD)
Entity Type:Individual
Prefix:
First Name:ROGELIO
Middle Name:
Last Name:IGLESIAS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7821 SW 24TH ST STE 117
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33155-6542
Mailing Address - Country:US
Mailing Address - Phone:305-264-7331
Mailing Address - Fax:
Practice Address - Street 1:7821 SW 24 SUITE 117
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33155-2538
Practice Address - Country:US
Practice Address - Phone:305-264-7331
Practice Address - Fax:305-264-7334
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2011-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME90682208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK7536Medicare PIN