Provider Demographics
NPI:1881603900
Name:PAUL A RODRIGUEZ DO PA
Entity type:Organization
Organization Name:PAUL A RODRIGUEZ DO PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR, PRESIDENT,SECRETARY,TREAS
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:A
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:DO, PA
Authorized Official - Phone:954-941-0484
Mailing Address - Street 1:1821 NE 25TH STREET
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LIGHTHOUSE POINT
Mailing Address - State:FL
Mailing Address - Zip Code:33064
Mailing Address - Country:US
Mailing Address - Phone:954-941-0484
Mailing Address - Fax:954-941-0485
Practice Address - Street 1:1821 NE 25TH ST
Practice Address - Street 2:SUITE 100
Practice Address - City:LIGHTHOUSE POINT
Practice Address - State:FL
Practice Address - Zip Code:33064-7744
Practice Address - Country:US
Practice Address - Phone:954-941-0484
Practice Address - Fax:954-941-0485
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-07
Last Update Date:2017-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS7048174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL285366OtherAVMED
FLDQ2139OtherRAILROAD MEDICARE
FLL4QH7OtherFLORIDA BLUE
FL49427OtherBCBS
FL257541800Medicaid
FL257541800Medicaid