Provider Demographics
NPI:1457232035
Name:VICIEDO CORREA, RODOLFO ESTEBAN
Entity type:Individual
Prefix:
First Name:RODOLFO
Middle Name:ESTEBAN
Last Name:VICIEDO CORREA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:777 NW 72ND AVE STE 2059
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33126-3181
Mailing Address - Country:US
Mailing Address - Phone:305-780-6558
Mailing Address - Fax:
Practice Address - Street 1:777 NW 72ND AVE STE 2059
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33126-3181
Practice Address - Country:US
Practice Address - Phone:305-780-6558
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-10
Last Update Date:2025-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies