Organization
PROFESSIONAL MEDICAL PRACTICE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. YANET RODRIGUEZ (PRESIDENT)
(305) 821-1613
Entity
Organization
Contact information
Practice address
11246 SW 137TH AVE STE 202A, MIAMI, FL 33186-4201
(786) 631-5999
(786) 362-5244
Mailing address
7221 SW 24 STREET, SUITE #202A, MIAMI, FL 33155
(786) 294-0811
(786) 362-5244
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
HCC10584
FL
225100000X
Physical Therapist
HCC10584
FL
261Q00000X
Clinic/Center
—
—
261QA0600X
Adult Day Care Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
261QA0600X
—
FL
Enumeration date
02/04/2016
Last updated
01/26/2023
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