Basic Information
| Provider Information | |||||||||
| NPI: | 1831347707 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RODRIGUEZ | ||||||||
| FirstName: | RAUL | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2985 SW 145TH AVE | ||||||||
| Address2: | |||||||||
| City: | MIAMI | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331757454 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3055512137 | ||||||||
| FaxNumber: | 3055512137 | ||||||||
| Practice Location | |||||||||
| Address1: | 9025 PINES BLVD | ||||||||
| Address2: | |||||||||
| City: | PEMBROKE PINES | ||||||||
| State: | FL | ||||||||
| PostalCode: | 330246440 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9544384000 | ||||||||
| FaxNumber: | 9544386000 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/04/2008 | ||||||||
| LastUpdateDate: | 11/20/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 172V00000X | ME102571 | FL | Y | Other Service Providers | Community Health Worker |
No ID Information.