Provider Demographics
NPI:1790542041
Name:RODRIGUEZ, SEBASTIAN (RD)
Entity Type:Individual
Prefix:
First Name:SEBASTIAN
Middle Name:
Last Name:RODRIGUEZ
Suffix:
Gender:M
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:337 20TH ST APT 212
Mailing Address - Street 2:
Mailing Address - City:MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33139-1981
Mailing Address - Country:US
Mailing Address - Phone:305-742-4125
Mailing Address - Fax:
Practice Address - Street 1:337 20TH ST APT 212
Practice Address - Street 2:
Practice Address - City:MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33139-1981
Practice Address - Country:US
Practice Address - Phone:305-742-4125
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-04
Last Update Date:2024-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL12993133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered