Provider Demographics
NPI:1083791941
Name:RODRIGUEZ, EVELYN (MD)
Entity type:Individual
Prefix:
First Name:EVELYN
Middle Name:
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1565 SAXON BLVD STE 102
Mailing Address - Street 2:
Mailing Address - City:DELTONA
Mailing Address - State:FL
Mailing Address - Zip Code:32725-5823
Mailing Address - Country:US
Mailing Address - Phone:386-917-7395
Mailing Address - Fax:386-532-7152
Practice Address - Street 1:1565 SAXON BLVD STE 102
Practice Address - Street 2:
Practice Address - City:DELTONA
Practice Address - State:FL
Practice Address - Zip Code:32725-5823
Practice Address - Country:US
Practice Address - Phone:386-917-7395
Practice Address - Fax:386-532-7152
Is Sole Proprietor?:No
Enumeration Date:2006-10-31
Last Update Date:2024-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00044960207Q00000X
FLME145161207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8426819OtherCHPW
WA9392ROOtherREGENCE
WA8426819Medicaid
WA0208233OtherL & I
911019392OtherCOMMERCIAL
FL106651100Medicaid
WA9392ROOtherREGENCE