Provider Demographics
NPI:1184148603
Name:RODRIGUEZ, ROLANDO J (MD)
Entity type:Individual
Prefix:DR
First Name:ROLANDO
Middle Name:J
Last Name:RODRIGUEZ
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 1:714 NW 122ND PL
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33182-2013
Mailing Address - Country:US
Mailing Address - Phone:305-310-5708
Mailing Address - Fax:
Practice Address - Street 1:714 NW 122ND PL
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33182-2013
Practice Address - Country:US
Practice Address - Phone:305-310-5708
Practice Address - Fax:305-310-5708
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-26
Last Update Date:2023-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLTN46929246QM0706X
FLACN1559208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No246QM0706XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, PathologyMedical Technologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL246ZC0007XMedicaid