Basic Information
| Provider Information | |||||||||
| NPI: | 1811198963 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RODRIGUEZ | ||||||||
| FirstName: | JOSE | ||||||||
| MiddleName: | A | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 7623 | ||||||||
| Address2: | |||||||||
| City: | NAPLES | ||||||||
| State: | FL | ||||||||
| PostalCode: | 341017623 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3057127229 | ||||||||
| FaxNumber: | 3053971139 | ||||||||
| Practice Location | |||||||||
| Address1: | 3663 S MIAMI AVE | ||||||||
| Address2: | |||||||||
| City: | MIAMI | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331334253 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3058544400 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/29/2007 | ||||||||
| LastUpdateDate: | 07/05/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/05/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | ME97625 | FL | Y | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology | 2085R0204X | ME97625 | FL | N | Allopathic & Osteopathic Physicians | Radiology | Vascular & Interventional Radiology |
ID Information
| ID | Type | State | Issuer | Description | 14119648 | 01 | FL | CAQH | OTHER | P01258555 | 01 | FL | FLORIDA MEDICARE RAILROAD | OTHER | 105370800 | 05 | FL | MEDICAID | CH686X | 01 | FL | FLORIDA MEDICARE | OTHER | 145YK | 01 | FL | FLORIDA BLUE (BCBS) | OTHER |