Healthcare Provider Details

I. General information

NPI: 1811986979
Provider Name (Legal Business Name): ANA I RODRIGUEZ MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/20/2005
Last Update Date: 09/13/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

LIZZIE GRAHAM ST JR10
LEVITOWN PR
00949
US

IV. Provider business mailing address

PO BOX 482
SABANA SECA PR
00952-0482
US

V. Phone/Fax

Practice location:
  • Phone: 787-784-1470
  • Fax: 787-795-9164
Mailing address:
  • Phone: 787-784-1470
  • Fax: 787-795-9164

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number10311
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: