Provider Demographics
NPI:1710920434
Name:VICENTE RODRIGUEZ M D P A
Entity Type:Organization
Organization Name:VICENTE RODRIGUEZ M D P A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:VICENTE
Authorized Official - Middle Name:
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD, MBA
Authorized Official - Phone:305-383-6200
Mailing Address - Street 1:PO BOX 650878
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33265-0878
Mailing Address - Country:US
Mailing Address - Phone:305-383-6200
Mailing Address - Fax:305-383-6177
Practice Address - Street 1:12955 SW 42ND ST
Practice Address - Street 2:SUITE 12
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33175-2902
Practice Address - Country:US
Practice Address - Phone:305-383-6200
Practice Address - Fax:305-383-6177
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0805XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyGeriatric PsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLF79178Medicare UPIN
25185Medicare ID - Type Unspecified