Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0505X | Family Doctor - Adult Medicine | ME81643 | FL |
NPI | 1093864548 |
---|---|
Provider Name | Carlos O Rodriguez |
First Address | Miami, FL 33145-2538 |
Second Address | Miami, FL 33145-2538 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/01/2007 |
Last Update Date | 05/02/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
259017400 | (05) | FL |
H31343 | (02) | FL |