Healthcare Provider Details

I. General information

NPI: 1912311556
Provider Name (Legal Business Name): MARINA RODRIGUEZ MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2014
Last Update Date: 04/22/2020
Certification Date: 04/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

BDAACH/549TH HOSPITAL CENTER USAG HUMPHREYS, BUILDING 3030
APO AP
96271
US

IV. Provider business mailing address

PSC 444 BOX 1553
APO AP
96297-0016
US

V. Phone/Fax

Practice location:
  • Phone: 315-737-1262
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number28817
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: