Provider Demographics
NPI:1447275367
Name:RODRIGUEZ MEDICAL CORP
Entity type:Organization
Organization Name:RODRIGUEZ MEDICAL CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LUIS
Authorized Official - Middle Name:
Authorized Official - Last Name:GINORIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-888-3404
Mailing Address - Street 1:800 PALM AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33010-4353
Mailing Address - Country:US
Mailing Address - Phone:305-888-3404
Mailing Address - Fax:305-888-3410
Practice Address - Street 1:800 PALM AVE
Practice Address - Street 2:SUITE A
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33010-4353
Practice Address - Country:US
Practice Address - Phone:305-888-3404
Practice Address - Fax:305-888-3410
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-13
Last Update Date:2009-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261Q00000X
FLHCC7128261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL276722800Medicaid
FL=========OtherEIN
FL276722800Medicaid