Basic Information
| Provider Information | |||||||||
| NPI: | 1184932865 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | AVERHOFF AND RODRIGUEZ MD PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 20230 NW 5TH ST | ||||||||
| Address2: | |||||||||
| City: | PEMBROKE PINES | ||||||||
| State: | FL | ||||||||
| PostalCode: | 330293413 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9544320578 | ||||||||
| FaxNumber: | 9544325060 | ||||||||
| Practice Location | |||||||||
| Address1: | 20230 NW 5TH ST | ||||||||
| Address2: | |||||||||
| City: | PEMBROKE PINES | ||||||||
| State: | FL | ||||||||
| PostalCode: | 330293413 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9544320578 | ||||||||
| FaxNumber: | 9544325060 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/16/2010 | ||||||||
| LastUpdateDate: | 09/16/2010 | ||||||||
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| AuthorizedOfficialLastName: | MALETA | ||||||||
| AuthorizedOfficialFirstName: | GREIDYS | ||||||||
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| AuthorizedOfficialTitleorPosition: | MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 9544320578 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | ME0033998 | FL | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 29176 | 01 | FL | BCBS | OTHER | ME0033998 | 01 | FL | MEDICAL LICENSE | OTHER |