Provider Demographics
NPI:1255364113
Name:RODRIGUEZ, LUCERO M (MD)
Entity type:Individual
Prefix:DR
First Name:LUCERO
Middle Name:M
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 1:1874 SW 138TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33175-7500
Mailing Address - Country:US
Mailing Address - Phone:305-718-9800
Mailing Address - Fax:305-718-9080
Practice Address - Street 1:10305 NW 41ST ST STE 202
Practice Address - Street 2:
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33178
Practice Address - Country:US
Practice Address - Phone:305-718-9800
Practice Address - Fax:305-718-9080
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-07
Last Update Date:2018-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME938062084P0805X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0805XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyGeriatric Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL274216100Medicaid
FLK9311Medicare ID - Type UnspecifiedGROUP
FL274216100Medicaid
FLU6801AMedicare ID - Type UnspecifiedINDIVIDUAL PROVIDER NO