Provider Demographics
NPI:1912930744
Name:RODRIGUEZ ANGULO, JESUS N (MD)
Entity type:Individual
Prefix:
First Name:JESUS
Middle Name:N
Last Name:RODRIGUEZ ANGULO
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 1:10980 SW 25TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33165
Mailing Address - Country:US
Mailing Address - Phone:305-310-1648
Mailing Address - Fax:304-220-6776
Practice Address - Street 1:45 NW 8TH ST STE 110
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33030-4452
Practice Address - Country:US
Practice Address - Phone:305-248-1900
Practice Address - Fax:305-248-1902
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2024-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME500882080P0204X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2080P0204XAllopathic & Osteopathic PhysiciansPediatricsPediatric Emergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL047411800Medicaid