Active NPI
Marielys Janice Rodriguez Distasi, DMD
- Dentist
- Riverview, FL
National Provider Identifier
1760173777
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 30649
- Practice address
- 10672 Bloomingdale Ave Unit 102
Riverview, FL 33578-4291 - Phone
- (813) 454-0776
- NPI assigned
- May 19, 2023
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 30649 | FL | Primary |
Addresses
Primary practice location
10672 Bloomingdale Ave Unit 102
Riverview, FL 33578-4291
Mailing address
14864 Summer Branch Dr
Lithia, FL 33547-5130
Phone (813) 435-8332
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 30649 | FL | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1684454400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1775606400000",
"number": "1760173777",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "14864 SUMMER BRANCH DR",
"city": "LITHIA",
"state": "FL",
"postal_code": "335475130",
"telephone_number": "813-435-8332"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "10672 BLOOMINGDALE AVE UNIT 102",
"city": "RIVERVIEW",
"state": "FL",
"postal_code": "335784291",
"telephone_number": "813-454-0776"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RODRIGUEZ DISTASI",
"first_name": "MARIELYS",
"middle_name": "JANICE",
"name_prefix": "Dr.",
"credential": "DMD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2023-05-19",
"last_updated": "2026-04-08",
"certification_date": "2026-04-08",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "FL",
"license": "30649",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Riverview, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 8, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.