Provider Demographics
NPI:1851693865
Name:UBALDO S. RODRIGUEZ, M.D.,P.A.
Entity Type:Organization
Organization Name:UBALDO S. RODRIGUEZ, M.D.,P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:UBALDO
Authorized Official - Middle Name:S
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-557-4020
Mailing Address - Street 1:3375 W 4TH AVE
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-4360
Mailing Address - Country:US
Mailing Address - Phone:305-557-4020
Mailing Address - Fax:305-888-6114
Practice Address - Street 1:3375 W 4TH AVE
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-4360
Practice Address - Country:US
Practice Address - Phone:305-557-4020
Practice Address - Fax:305-888-6114
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-23
Last Update Date:2010-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL25253174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL059141600Medicaid
FLD79548Medicare UPIN
FL059141600Medicaid