Provider Demographics
NPI:1700989795
Name:RODRIGUEZ, MAGALY ADELAIDA (MD)
Entity type:Individual
Prefix:DR
First Name:MAGALY
Middle Name:ADELAIDA
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11140 SW 88TH ST
Mailing Address - Street 2:STE 100
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33176-0901
Mailing Address - Country:US
Mailing Address - Phone:305-279-1872
Mailing Address - Fax:305-503-7508
Practice Address - Street 1:6919 N DALE MABRY HWY STE 210
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33614-3972
Practice Address - Country:US
Practice Address - Phone:813-558-4900
Practice Address - Fax:813-558-2155
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-06
Last Update Date:2021-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME71831208600000X, 2083P0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083P0011XAllopathic & Osteopathic PhysiciansPreventive MedicineUndersea and Hyperbaric Medicine
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL253579300Medicaid
FLG62098Medicare UPIN
FL42240BMedicare ID - Type Unspecified