Wilson Omar Rodriguez, PA

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

TPPA690 Issued in FL

Practice address

217 E Central Ave
Winter Haven, FL 33880-6312

Phone

(407) 315-3637

NPI assigned

Apr 29, 2024

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• We Care Family Physicians LLC

  • General Practice Physician
  • Winter Haven, FL
  • NPI 1730777053
  NPD
• We Care Specialty Physicians LLC

  • Multi-Specialty Clinic/Center
  • Winter Haven, FL
  • NPI 1396508719
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1714348800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1716508800000",
    "number": "1063268209",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 532",
            "city": "LAKE ALFRED",
            "state": "FL",
            "postal_code": "338500532",
            "telephone_number": "407-315-3637",
            "fax_number": "407-358-3440"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "217 E CENTRAL AVE",
            "city": "WINTER HAVEN",
            "state": "FL",
            "postal_code": "338806312",
            "telephone_number": "407-315-3637"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RODRIGUEZ",
        "first_name": "WILSON",
        "middle_name": "OMAR",
        "name_prefix": "Dr.",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2024-04-29",
        "last_updated": "2024-05-24",
        "certification_date": "2024-05-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "PR",
            "license": "2146-PA",
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "FL",
            "license": "TPPA690",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Christopher Lewis Rodriguez, PA
• Lia Susana Rodriguez
• Lorenza A Rodriguez
• Melissa Rodriguez
• Sandra Lizette Rodriguez, M.S.
• Kearria Rogers
• Kenneth Benjamine Rogers, DMD
• Emily Marie Rohan, APRN
• Elizabeth Casidy Rojas, DMD
• Ebony Monique Rollins, ARNP

• Medical Physician Assistant in Winter Haven, FL
• Providers in Winter Haven, FL by specialty
• Medical Physician Assistant in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 24, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.