Provider Demographics
NPI:1730467721
Name:OSVALDO RODRIGUEZ M.D., P.A.
Entity Type:Organization
Organization Name:OSVALDO RODRIGUEZ M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:OSVALDO
Authorized Official - Middle Name:
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:813-514-0335
Mailing Address - Street 1:2504 MILLER WOODS CT
Mailing Address - Street 2:
Mailing Address - City:VALRICO
Mailing Address - State:FL
Mailing Address - Zip Code:33594-3819
Mailing Address - Country:US
Mailing Address - Phone:813-514-0335
Mailing Address - Fax:813-514-0337
Practice Address - Street 1:3115 W COLUMBUS DR
Practice Address - Street 2:SUITE 107
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33607-1865
Practice Address - Country:US
Practice Address - Phone:813-514-0335
Practice Address - Fax:813-514-0337
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-26
Last Update Date:2011-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME57780207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL262377300Medicaid
FL11763Medicare PIN
FLE74793Medicare UPIN