Provider Demographics
NPI:1851466031
Name:RODRIGUEZ UBINAS, FANNY L (MD)
Entity Type:Individual
Prefix:
First Name:FANNY
Middle Name:L
Last Name:RODRIGUEZ UBINAS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13926 SW 47TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33175-4404
Mailing Address - Country:US
Mailing Address - Phone:855-226-6633
Mailing Address - Fax:866-285-7068
Practice Address - Street 1:13926 SW 47TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33175-4404
Practice Address - Country:US
Practice Address - Phone:855-226-6633
Practice Address - Fax:866-285-7068
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-22
Last Update Date:2024-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR16561208D00000X
FLACN944208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL022369800Medicaid