Healthcare Provider Details

I. General information

NPI: 1316048119
Provider Name (Legal Business Name): AMARYLLIS AYMAT-RODRIGUEZ MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/26/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARRETERA 159 0.9 DESVIO DE COROZAL BARRIO ABRA
COROZAL PR
00783-9750
US

IV. Provider business mailing address

PLAZA 12 D-9 CAMBRIDGE PARK
SAN JUAN PR
00926-1450
US

V. Phone/Fax

Practice location:
  • Phone: 787-859-2560
  • Fax:
Mailing address:
  • Phone: 787-764-6477
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number7730
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: