1548286446 NPI number — DORIS ADRIANA RODRIGUEZ M.D.

Table of content: DORIS ADRIANA RODRIGUEZ M.D. (NPI 1548286446)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1548286446 NPI number — DORIS ADRIANA RODRIGUEZ M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RODRIGUEZ
Provider First Name:
DORIS
Provider Middle Name:
ADRIANA
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1548286446
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/06/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2234 QUAIL ROOST DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WESTON
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33327-1447
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
954-660-0695
Provider Business Mailing Address Fax Number:
253-830-7668

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2950 CLEVELAND CLINIC BLVD
Provider Second Line Business Practice Location Address:
NEUROLOGY DEPARTMENT
Provider Business Practice Location Address City Name:
WESTON
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33331-3609
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
954-659-5000
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/14/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2084N0400X , with the licence number:  36-116321 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 36-116321 . This is a "ILLINOIS MEDICAL LICENSE" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 278795400 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".