Healthcare Provider Details

I. General information

NPI: 1912002361
Provider Name (Legal Business Name): MIRIAM NOELIA ALICEA-RODRIGUEZ MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/13/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CALLE MUNOZ MARIN ESQ MIGUEL CASILLAS #50
HUMACAO PR
00791
US

IV. Provider business mailing address

PO BOX 9001
HUMACAO PR
00792-9001
US

V. Phone/Fax

Practice location:
  • Phone: 787-850-7950
  • Fax: 787-285-8026
Mailing address:
  • Phone: 787-850-7950
  • Fax: 787-285-8026

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0205X
TaxonomyPediatric Endocrinology Physician
License Number6476
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: