Provider Demographics
NPI:1942506522
Name:VICTOR RODRIGUEZ-VIERA MD PA
Entity Type:Organization
Organization Name:VICTOR RODRIGUEZ-VIERA MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING/OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LIESA
Authorized Official - Middle Name:
Authorized Official - Last Name:GRAHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:772-562-1204
Mailing Address - Street 1:1820 43RD AVE STE 2
Mailing Address - Street 2:
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32960-0540
Mailing Address - Country:US
Mailing Address - Phone:772-562-1204
Mailing Address - Fax:772-562-3242
Practice Address - Street 1:1820 43RD AVE STE 2
Practice Address - Street 2:
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32960-0540
Practice Address - Country:US
Practice Address - Phone:772-562-1204
Practice Address - Fax:772-562-3242
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-31
Last Update Date:2011-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLD85602Medicare UPIN