Provider Demographics
NPI:1639989395
Name:FLEITAS RODRIGUEZ, MARYLU
Entity type:Individual
Prefix:
First Name:MARYLU
Middle Name:
Last Name:FLEITAS RODRIGUEZ
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4770 BISCAYNE BLVD STE 1450
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33137-3237
Mailing Address - Country:US
Mailing Address - Phone:786-536-2003
Mailing Address - Fax:800-536-1148
Practice Address - Street 1:4770 BISCAYNE BLVD STE 1450
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33137-3237
Practice Address - Country:US
Practice Address - Phone:786-536-2003
Practice Address - Fax:800-536-1148
Is Sole Proprietor?:No
Enumeration Date:2025-01-13
Last Update Date:2025-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLF12240062363LF0000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily