| Ivan D Rodriguez D O P A | |
|
7100 W 20th Ave Suite 504 Hialeah FL 33016-1897 | |
| (305) 827-3330 | |
| (305) 824-4699 |
| Full Name | Ivan D Rodriguez D O P A |
|---|---|
| Speciality | Family Medicine |
| Location | 7100 W 20th Ave, Hialeah, Florida |
| Authorized Official Name and Position | Ivan D Rodriguez (PRESIDENT) |
| Authorized Official Contact | 3058240706 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Ivan D Rodriguez D O P A 7777 Nw 167th Ter Miami Lakes FL 33016-8452 Ph: (305) 824-0706 | Ivan D Rodriguez D O P A 7100 W 20th Ave Suite 504 Hialeah FL 33016-1897 Ph: (305) 827-3330 |
| NPI Number | 1376625780 |
|---|---|
| Provider Enumeration Date | 10/19/2006 |
| Last Update Date | 12/03/2007 |
| Medicare PECOS PAC ID | 4284603648 |
|---|---|
| Medicare Enrollment ID | O20041001000350 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1376625780 | NPI | - | NPPES |
| 267179400 | Medicaid | FL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207QG0300X | Family Medicine - Geriatric Medicine | OS7908 (Florida) | Primary |
| Provider Name | Ivan D Rodriguez |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1649292012 PECOS PAC ID: 3072582436 Enrollment ID: I20071106000674 |
| Provider Name | Vanessa S Samaniego |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1306307772 PECOS PAC ID: 2062894660 Enrollment ID: I20220728002987 |
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