Provider Demographics
NPI:1932407103
Name:LEA PLAZA, RODOLFO (DDS)
Entity type:Individual
Prefix:DR
First Name:RODOLFO
Middle Name:
Last Name:LEA PLAZA
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 W 65TH ST
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-6640
Mailing Address - Country:US
Mailing Address - Phone:305-827-0434
Mailing Address - Fax:305-827-1501
Practice Address - Street 1:400 W 65 ST
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012
Practice Address - Country:US
Practice Address - Phone:305-827-0434
Practice Address - Fax:305-827-1501
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-11
Last Update Date:2024-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN192401223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL015905000Medicaid