Provider Demographics
NPI:1023132578
Name:RODRIGUEZ, MARIA ELENA (MD)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:ELENA
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MARIA
Other - Middle Name:ELENA
Other - Last Name:RODRIGUEZ GARCIA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:308 W BASS ST
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34741-5001
Mailing Address - Country:US
Mailing Address - Phone:407-483-8801
Mailing Address - Fax:407-483-1298
Practice Address - Street 1:5626 CURRY FORD RD
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32822
Practice Address - Country:US
Practice Address - Phone:407-985-5677
Practice Address - Fax:844-388-6186
Is Sole Proprietor?:No
Enumeration Date:2007-03-19
Last Update Date:2019-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME100303207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL016832600Medicaid
FL016832600Medicaid