Provider Demographics
NPI:1093374183
Name:RODULFO RODRIGUEZ, ALEJANDRO ENRIQUE (MD)
Entity type:Individual
Prefix:
First Name:ALEJANDRO
Middle Name:ENRIQUE
Last Name:RODULFO RODRIGUEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2900 CORPORATE WAY
Mailing Address - Street 2:DOOR D
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33025-6818
Mailing Address - Country:US
Mailing Address - Phone:954-276-5603
Mailing Address - Fax:954-985-7074
Practice Address - Street 1:3440 HOLLYWOOD BLVD STE 360
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021-6934
Practice Address - Country:US
Practice Address - Phone:954-276-9240
Practice Address - Fax:954-276-0103
Is Sole Proprietor?:No
Enumeration Date:2019-06-11
Last Update Date:2024-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME1629192084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLTRN29341OtherFLORIDA MEDICAL LICENSE: REGISTRATION FOR RESIDENT/HSE PHYSICIAN