Provider Demographics
NPI:1255428926
Name:RODRIGUEZ-MARTIRENA, ALFREDO I (MD)
Entity type:Individual
Prefix:
First Name:ALFREDO
Middle Name:I
Last Name:RODRIGUEZ-MARTIRENA
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 1:14750 NW 77TH CT
Mailing Address - Street 2:
Mailing Address - City:MIAMI LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33016-1507
Mailing Address - Country:US
Mailing Address - Phone:305-557-2949
Mailing Address - Fax:305-557-2410
Practice Address - Street 1:14750 NW 77TH CT
Practice Address - Street 2:
Practice Address - City:MIAMI LAKES
Practice Address - State:FL
Practice Address - Zip Code:33016-1507
Practice Address - Country:US
Practice Address - Phone:305-557-2949
Practice Address - Fax:305-557-2410
Is Sole Proprietor?:No
Enumeration Date:2006-10-06
Last Update Date:2016-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME56111174400000X, 207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL063437100Medicaid
FL063437100Medicaid