Healthcare Provider Details

I. General information

NPI: 1932178910
Provider Name (Legal Business Name): WANDALIZ RODRIGUEZ GUZMAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/14/2006
Last Update Date: 10/24/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARR. 459, KM 3.9 BO. CAMASEYES
AGUADILLA PR
00603-6083
US

IV. Provider business mailing address

PO BOX 5164
AGUADILLA PUERTO RICO
00605
UM

V. Phone/Fax

Practice location:
  • Phone: 787-243-6215
  • Fax: 787-243-6215
Mailing address:
  • Phone: 787-243-6215
  • Fax: 787-243-6215

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number13789
License Number StatePR
# 2
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number13789
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: