Provider Demographics
NPI:1639672967
Name:RODRIGUEZ MILANES, ROBERTO (SA-C)
Entity Type:Individual
Prefix:
First Name:ROBERTO
Middle Name:
Last Name:RODRIGUEZ MILANES
Suffix:
Gender:M
Credentials:SA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1629 NW 14TH ST APT 911
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33125-2673
Mailing Address - Country:US
Mailing Address - Phone:786-484-3988
Mailing Address - Fax:
Practice Address - Street 1:1629 NW 14TH ST APT 911
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33125-2673
Practice Address - Country:US
Practice Address - Phone:786-484-3988
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-13
Last Update Date:2018-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL13-197363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical