Provider Demographics
NPI:1265546063
Name:RODRIQUEZ-MENDEZ, JORGE L (MD)
Entity type:Individual
Prefix:
First Name:JORGE
Middle Name:L
Last Name:RODRIQUEZ-MENDEZ
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 1:6101 BLUE LAGOON DR STE 400
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33126-2051
Mailing Address - Country:US
Mailing Address - Phone:305-661-3492
Mailing Address - Fax:
Practice Address - Street 1:15516 SW 88TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33196-1554
Practice Address - Country:US
Practice Address - Phone:305-387-3300
Practice Address - Fax:305-383-4945
Is Sole Proprietor?:No
Enumeration Date:2006-08-18
Last Update Date:2021-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME47781207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL035108300Medicaid
FL08700WMedicare ID - Type Unspecified