Provider Demographics
NPI:1780971754
Name:RODRIGUEZ VALDES, ERNESTO (MD)
Entity type:Individual
Prefix:DR
First Name:ERNESTO
Middle Name:
Last Name:RODRIGUEZ VALDES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 NW 57TH AVE STE 150
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33126-2072
Mailing Address - Country:US
Mailing Address - Phone:305-260-2680
Mailing Address - Fax:305-260-2686
Practice Address - Street 1:701 NW 57TH AVE STE 150
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33126-2072
Practice Address - Country:US
Practice Address - Phone:305-260-2680
Practice Address - Fax:305-260-2686
Is Sole Proprietor?:No
Enumeration Date:2011-06-28
Last Update Date:2024-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME111630207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL106139700Medicaid
FL14POROtherBCBS
FLLF335OtherMEDICARE
FL005931300Medicaid
NH3114572Medicaid
NHT400447304OtherMEDICARE B