Provider Demographics
NPI:1710409255
Name:DE LA MATTA RODRIGUEZ, CLAUDIA PATRICIA (MD)
Entity Type:Individual
Prefix:
First Name:CLAUDIA
Middle Name:PATRICIA
Last Name:DE LA MATTA RODRIGUEZ
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:2900 CORPORATE WAY
Mailing Address - Street 2:DOOR D
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33025-3925
Mailing Address - Country:US
Mailing Address - Phone:954-276-5685
Mailing Address - Fax:954-985-7074
Practice Address - Street 1:5647 HOLLYWOOD BLVD
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021-6325
Practice Address - Country:US
Practice Address - Phone:954-276-1616
Practice Address - Fax:954-985-6186
Is Sole Proprietor?:No
Enumeration Date:2017-07-15
Last Update Date:2023-02-14
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FL154984207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL114869700Medicaid