Provider Demographics
NPI:1699218024
Name:RODRIGUEZ, LEONARDO (PA-C)
Entity type:Individual
Prefix:MR
First Name:LEONARDO
Middle Name:
Last Name:RODRIGUEZ
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1321 NW 14 STREET
Mailing Address - Street 2:SUITE 202
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33125-2918
Mailing Address - Country:US
Mailing Address - Phone:305-324-0220
Mailing Address - Fax:305-545-0790
Practice Address - Street 1:1321 NW 14TH ST STE 202
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33125-1653
Practice Address - Country:US
Practice Address - Phone:305-324-0220
Practice Address - Fax:305-545-0790
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-03
Last Update Date:2022-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9110038363AM0700X, 363AS0400X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical