Provider Demographics
NPI:1386710572
Name:RODRIGUEZ, PEDRO A (MD)
Entity type:Individual
Prefix:
First Name:PEDRO
Middle Name:A
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 1:258 NE 27TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33137-4522
Mailing Address - Country:US
Mailing Address - Phone:305-573-9898
Mailing Address - Fax:305-573-3711
Practice Address - Street 1:258 NE 27TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33137-4522
Practice Address - Country:US
Practice Address - Phone:305-573-9898
Practice Address - Fax:305-573-3711
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-28
Last Update Date:2014-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME00286642084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL038213200Medicaid
FL92961Medicare PIN
FL038213200Medicaid