Healthcare Provider Details

I. General information

NPI: 1679254577
Provider Name (Legal Business Name): CELIMAR RODRIGUEZ RODRIGUEZ MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2023
Last Update Date: 07/10/2025
Certification Date: 06/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CALLE HERNANDEZ CARRION
MANATI PR
00674
US

IV. Provider business mailing address

89 URBANIZACION VISTA DEL VALLE
MANATI PR
00674
US

V. Phone/Fax

Practice location:
  • Phone: 787-621-3700
  • Fax:
Mailing address:
  • Phone: 787-688-1837
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number17395I
License Number StatePR
# 2
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number1784
License Number StatePR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: