Provider Demographics
NPI:1487968764
Name:RODRIGUEZ, ANIELKA RAFAELA (MD)
Entity type:Individual
Prefix:
First Name:ANIELKA
Middle Name:RAFAELA
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 1:3300 S FISKE BLVD
Mailing Address - Street 2:
Mailing Address - City:ROCKLEDGE
Mailing Address - State:FL
Mailing Address - Zip Code:32955-4306
Mailing Address - Country:US
Mailing Address - Phone:407-900-0613
Mailing Address - Fax:
Practice Address - Street 1:2915 LAKEVIEW DR STE 1001
Practice Address - Street 2:
Practice Address - City:FERN PARK
Practice Address - State:FL
Practice Address - Zip Code:32730-2009
Practice Address - Country:US
Practice Address - Phone:407-900-0613
Practice Address - Fax:407-335-6945
Is Sole Proprietor?:No
Enumeration Date:2010-07-29
Last Update Date:2021-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME117966207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLNH879OtherFL MEDICARE