Provider Demographics
NPI:1760643019
Name:ALICIA RODRIGUEZ -JORGE M D P A
Entity Type:Organization
Organization Name:ALICIA RODRIGUEZ -JORGE M D P A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:RODRIGUEZ -JORGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-859-7719
Mailing Address - Street 1:2921 SW 8TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33135-2826
Mailing Address - Country:US
Mailing Address - Phone:305-859-7719
Mailing Address - Fax:
Practice Address - Street 1:2921 SW 8TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33135-2826
Practice Address - Country:US
Practice Address - Phone:305-859-7719
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-19
Last Update Date:2014-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL78063174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE3105BOtherMEDICARE ID
FLH04097Medicare UPIN