Healthcare Provider Details

I. General information

NPI: 1619023314
Provider Name (Legal Business Name): MIGDALIA RODRIGUEZ MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/26/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

SANCHEZ OSORIO AVE 5A3 VILLA FONTANA
CAROLINA PR
00983
US

IV. Provider business mailing address

PO BOX 312
CAROLINA PR
00986-0312
US

V. Phone/Fax

Practice location:
  • Phone: 787-762-2380
  • Fax: 787-276-9687
Mailing address:
  • Phone: 787-762-2380
  • Fax: 787-276-9687

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number13981
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: