Provider Demographics
NPI:1760560999
Name:RODRIGUEZ, CARLOS RAFAEL (MD)
Entity Type:Individual
Prefix:
First Name:CARLOS
Middle Name:RAFAEL
Last Name:RODRIGUEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2754 NW 147TH ST
Mailing Address - Street 2:
Mailing Address - City:NEWBERRY
Mailing Address - State:FL
Mailing Address - Zip Code:32669-2097
Mailing Address - Country:US
Mailing Address - Phone:787-667-6474
Mailing Address - Fax:
Practice Address - Street 1:6800 NW 9TH BLVD STE 3
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32605-4257
Practice Address - Country:US
Practice Address - Phone:352-333-5540
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-02
Last Update Date:2023-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 966252084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry