Provider Demographics
NPI:1649315367
Name:RODRIGUEZ, MIGUEL ANGEL (AART)
Entity type:Individual
Prefix:
First Name:MIGUEL
Middle Name:ANGEL
Last Name:RODRIGUEZ
Suffix:
Gender:M
Credentials:AART
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15330 SW 170TH TER
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33187-6712
Mailing Address - Country:US
Mailing Address - Phone:305-803-2211
Mailing Address - Fax:305-643-5728
Practice Address - Street 1:1393 SW 1ST ST
Practice Address - Street 2:210
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33135-2321
Practice Address - Country:US
Practice Address - Phone:305-643-5722
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL171611247100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247100000XTechnologists, Technicians & Other Technical Service ProvidersRadiologic Technologist