Provider Demographics
NPI:1942366794
Name:FERRETTI, RODOLFO B (MD)
Entity Type:Individual
Prefix:DR
First Name:RODOLFO
Middle Name:B
Last Name:FERRETTI
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 1:13601 SW 102ND AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33176-6606
Mailing Address - Country:US
Mailing Address - Phone:305-681-7770
Mailing Address - Fax:305-681-7968
Practice Address - Street 1:7765 SW 87 AVENUE
Practice Address - Street 2:SUITE # 209
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33173
Practice Address - Country:US
Practice Address - Phone:305-595-0429
Practice Address - Fax:305-595-0431
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-28
Last Update Date:2010-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME94646174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL275290500Medicaid