Healthcare Provider Details

I. General information

NPI: 1568517829
Provider Name (Legal Business Name): OLGA D RODRIGUEZ RODRIGUEZ M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/24/2007
Last Update Date: 12/06/2021
Certification Date: 12/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

388 ZONA IND REPARADA 2
PONCE PR
00716-2347
US

IV. Provider business mailing address

304 CALLE SOFIA MANSION REAL
COTO LAUREL PR
00780-2630
US

V. Phone/Fax

Practice location:
  • Phone: 787-840-2575
  • Fax: 787-840-9756
Mailing address:
  • Phone: 787-848-8816
  • Fax: 787-841-7165

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number8327
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: