Healthcare Provider Details

I. General information

NPI: 1962484774
Provider Name (Legal Business Name): OLGA RODRIGUEZ MD
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 11/17/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CALLE POST S EDIFICIO POST CENTER
MAYAGUEZ PR
00680-1729
US

IV. Provider business mailing address

PO BOX 366
MAYAGUEZ PR
00681-0366
US

V. Phone/Fax

Practice location:
  • Phone: 787-833-5450
  • Fax: 787-265-8844
Mailing address:
  • Phone: 787-833-5450
  • Fax: 787-265-8844

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number8182
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: