Provider Demographics
NPI:1316959349
Name:RODRIGUEZ, JOSE JOAQUIN (MD)
Entity type:Individual
Prefix:
First Name:JOSE
Middle Name:JOAQUIN
Last Name: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 1:5703 NW 7 STREET
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33126-3105
Mailing Address - Country:US
Mailing Address - Phone:305-266-2621
Mailing Address - Fax:305-266-2671
Practice Address - Street 1:5703 NW 7 STREET
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33126-3105
Practice Address - Country:US
Practice Address - Phone:305-266-2621
Practice Address - Fax:305-266-2671
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL82753208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
H53055Medicare UPIN
FLI6623ZMedicare ID - Type Unspecified