Healthcare Provider Details

I. General information

NPI: 1639289820
Provider Name (Legal Business Name): ANGELA M RODRIGUEZ TORMES MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 02/19/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5970 CHURCHVIEW DR PEDIATRICS
ROCKFORD IL
61107-2574
US

IV. Provider business mailing address

5970 CHURCHVIEW DR PEDIATRICS
ROCKFORD IL
61107-2574
US

V. Phone/Fax

Practice location:
  • Phone: 815-971-2000
  • Fax: 815-971-9267
Mailing address:
  • Phone: 815-971-2000
  • Fax: 815-971-9267

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number036-069024
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: