Healthcare Provider Details

I. General information

NPI: 1669581625
Provider Name (Legal Business Name): ALVILDA MARIA RODRIGUEZ OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 07/18/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PONCE OUTPATIENT CLINIC PASEO DEL VETERANO 1010
PONCE PR
00716-2001
US

IV. Provider business mailing address

VA-PONCE OUTPATIENT CLINIC 1010 PASEO DEL VETERANO
PONCE PR
00716-2001
US

V. Phone/Fax

Practice location:
  • Phone: 787-812-3030
  • Fax: 787-651-4320
Mailing address:
  • Phone: 787-812-3030
  • Fax: 787-651-4320

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number409
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: