Basic Information
| Provider Information | |||||||||
| NPI: | 1336802537 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RODRIGUEZ GOMEZ | ||||||||
| FirstName: | MONICA | ||||||||
| MiddleName: | MARIA | ||||||||
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| Credential: | APRN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8600 SW 92ND ST STE 204A | ||||||||
| Address2: | |||||||||
| City: | MIAMI | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331567377 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3054369933 | ||||||||
| FaxNumber: | 3054369944 | ||||||||
| Practice Location | |||||||||
| Address1: | 8525 SW 92ND ST STE D15 | ||||||||
| Address2: | |||||||||
| City: | MIAMI | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331567378 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3059129343 | ||||||||
| FaxNumber: | 3059127701 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/15/2021 | ||||||||
| LastUpdateDate: | 10/15/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/28/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LA2200X | APRN11015014 | FL | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Adult Health |
ID Information
| ID | Type | State | Issuer | Description | APRN11015014 | 01 | FL | LICENSE | OTHER |