Provider Demographics
NPI:1629356944
Name:RODRIGUEZ MEDICAL GROUP, PA, INC.
Entity Type:Organization
Organization Name:RODRIGUEZ MEDICAL GROUP, PA, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:INES
Authorized Official - Middle Name:
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP
Authorized Official - Phone:305-964-7689
Mailing Address - Street 1:15190 SW 136TH STREET
Mailing Address - Street 2:SUITE 15
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33196-2604
Mailing Address - Country:US
Mailing Address - Phone:305-964-7689
Mailing Address - Fax:305-964-7989
Practice Address - Street 1:15190 SW 136TH STREET
Practice Address - Street 2:SUITE 15
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33196-2604
Practice Address - Country:US
Practice Address - Phone:305-964-7689
Practice Address - Fax:305-964-7989
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-03
Last Update Date:2012-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME104034174400000X
FLARNP9243349363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty