| Entity Name: | CARLOS O. RODRIGUEZ, M.D., P.A. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 21 Aug 2001 (23 years ago) |
| Document Number: | P01000082180 |
| FEI/EIN Number | 651131153 |
| Address: | 1933 SW 27TH AVENUE, SUITE 101, MIAMI, FL, 33145, FL |
| Mail Address: | 1933 SW 27TH AVENUE, SUITE 101, MIAMI, FL, 33145, FL |
| ZIP code: | 33145 |
| County: | Miami-Dade |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1619294550 | 2010-05-03 | 2011-12-16 | 1933 SW 27TH AVE STE 101, MIAMI, FL, 331452538, US | 1933 SW 27TH AVE STE 101, MIAMI, FL, 331452538, US | |||||||||||||||||||||||||||||||
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| Phone | +1 305-858-2424 |
| Fax | 3058582445 |
Authorized person
| Name | CARLOS ORESTES RODRIGUEZ |
| Role | PRESIDENT |
| Phone | 3058582424 |
Taxonomy
| Taxonomy Code | 208D00000X - General Practice Physician |
| License Number | ME81643 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 259017400 |
| State | FL |
| Issuer | MEDICARE PTAN |
| Number | EF024A |
| State | FL |
| Name | Role | Address |
|---|---|---|
| RODRIGUEZ CARLOS OM.D. | Agent | 1933 SW 27TH AVENUE, MIAMI, FL, 33145 |
| Name | Role | Address |
|---|---|---|
| RODRIGUEZ CARLOS OM.D. | President | 1933 SW 27TH AVENUE SUITE 101, MIAMI, FL, 33145 |
| Name | Role | Address |
|---|---|---|
| RODRIGUEZ NOEMI | Vice President | 1933 SW 27TH AVENUE SUITE 101, MIAMI, FL, 33145 |
Date of last update: 01 Jan 2025
Sources: Florida Department of State
