Provider Demographics
NPI:1457766305
Name:ERNESTO RODRIGUEZ MD.PA.
Entity Type:Organization
Organization Name:ERNESTO RODRIGUEZ MD.PA.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ERNESTO
Authorized Official - Middle Name:
Authorized Official - Last Name:RODRIGUEZ VALDES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:786-383-7671
Mailing Address - Street 1:10300 SW 72ND ST
Mailing Address - Street 2:SUITE 230
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33173-3012
Mailing Address - Country:US
Mailing Address - Phone:786-383-7671
Mailing Address - Fax:
Practice Address - Street 1:10300 SW 72ND ST
Practice Address - Street 2:SUITE 230
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33173-3012
Practice Address - Country:US
Practice Address - Phone:786-383-7671
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-29
Last Update Date:2017-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME111630261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL005931300Medicaid
FL005931300Medicaid