Provider Demographics
NPI:1912917709
Name:GOTARDO A. RODRIGUES MD LLC
Entity Type:Organization
Organization Name:GOTARDO A. RODRIGUES MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GOTARDO
Authorized Official - Middle Name:
Authorized Official - Last Name:RODRIGUES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-642-6966
Mailing Address - Street 1:78 SW 13 AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33135-2483
Mailing Address - Country:US
Mailing Address - Phone:305-642-6966
Mailing Address - Fax:305-642-6965
Practice Address - Street 1:78 SW 13 AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33135-2483
Practice Address - Country:US
Practice Address - Phone:305-642-6966
Practice Address - Fax:305-642-6965
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-08
Last Update Date:2011-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME69345174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL=========OtherTAX ID