Provider Demographics
NPI:1356515019
Name:RODRIGUEZ, YANITZA (MD)
Entity type:Individual
Prefix:
First Name:YANITZA
Middle Name:
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10075 JOG ROAD STE 311
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33437
Mailing Address - Country:US
Mailing Address - Phone:561-509-6888
Mailing Address - Fax:561-509-6865
Practice Address - Street 1:10075 S JOG RD STE 311
Practice Address - Street 2:
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33437-3537
Practice Address - Country:US
Practice Address - Phone:561-509-6888
Practice Address - Fax:561-509-6865
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-14
Last Update Date:2020-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 107763207R00000X
FLME107763207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL004170100Medicaid