Provider Demographics
NPI:1194521898
Name:RODRIGUEZ MORENO, MARIO (ARNP)
Entity type:Individual
Prefix:
First Name:MARIO
Middle Name:
Last Name:RODRIGUEZ MORENO
Suffix:
Gender:
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13250 SW 58TH TER APT 10-9
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33183-1256
Mailing Address - Country:US
Mailing Address - Phone:786-458-1043
Mailing Address - Fax:
Practice Address - Street 1:13250 SW 58TH TER APT 10-9
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33183-1256
Practice Address - Country:US
Practice Address - Phone:786-458-1043
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-22
Last Update Date:2025-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11037685363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily