Provider Demographics
NPI:1699136606
Name:RODRIGUEZ, JONATHAN A
Entity type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:A
Last Name:RODRIGUEZ
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10383 SW 186TH ST
Mailing Address - Street 2:
Mailing Address - City:CUTLER BAY
Mailing Address - State:FL
Mailing Address - Zip Code:33157-6824
Mailing Address - Country:US
Mailing Address - Phone:202-393-9697
Mailing Address - Fax:
Practice Address - Street 1:10383 SW 186TH ST
Practice Address - Street 2:
Practice Address - City:CUTLER BAY
Practice Address - State:FL
Practice Address - Zip Code:33157-6824
Practice Address - Country:US
Practice Address - Phone:786-560-9069
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-18
Last Update Date:2025-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X, 171M00000X, 363AS0400X, 173000000X, 174H00000X, 251J00000X, 376K00000X
FL05140251002146D00000X
FLAI4732355A2700X
CD318374J00000X
FLHHA2910374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No146D00000XEmergency Medical Service ProvidersPersonal Emergency Response Attendant
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
No173000000XOther Service ProvidersLegal Medicine
No174H00000XOther Service ProvidersHealth Educator
No2355A2700XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistAudiology Assistant
No251J00000XAgenciesNursing Care
No374J00000XNursing Service Related ProvidersDoula
No374U00000XNursing Service Related ProvidersHome Health Aide
No376K00000XNursing Service Related ProvidersNurse's Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL115419300Medicaid