Provider Demographics
NPI:1982744314
Name:RODRIGUEZ AND SIXTO MEDICAL ASSOCIATES, P.A.
Entity Type:Organization
Organization Name:RODRIGUEZ AND SIXTO MEDICAL ASSOCIATES, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:RODRIGUEZ FUNDORA
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:305-644-1550
Mailing Address - Street 1:1100 SW 57 AVE #101
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33144
Mailing Address - Country:US
Mailing Address - Phone:305-644-1550
Mailing Address - Fax:305-269-1068
Practice Address - Street 1:1100 SW 57 AVE #101
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33144
Practice Address - Country:US
Practice Address - Phone:305-644-1550
Practice Address - Fax:305-269-1068
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-07
Last Update Date:2008-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS0007275207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL260231800Medicaid
FLK1405Medicare PIN