Provider Demographics
NPI:1053128215
Name:RODRIGUEZ, RONALD (SURGICAL ASSISTANT)
Entity type:Individual
Prefix:
First Name:RONALD
Middle Name:
Last Name:RODRIGUEZ
Suffix:
Gender:
Credentials:SURGICAL ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18040 SW 107TH AVE UNIT 106
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33157-5298
Mailing Address - Country:US
Mailing Address - Phone:786-799-0268
Mailing Address - Fax:
Practice Address - Street 1:18040 SW 107TH AVE UNIT 106
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33157-5298
Practice Address - Country:US
Practice Address - Phone:786-799-0268
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-11
Last Update Date:2025-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL22-448246ZC0007X
FL24-448246ZC0007X
363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant