Healthcare Provider Details

I. General information

NPI: 1164102828
Provider Name (Legal Business Name): ALEXIS G RODRIGUEZ RIVERA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: GLORIVEE RODRIGUEZ RIVERA MD

II. Dates (important events)

Enumeration Date: 07/18/2023
Last Update Date: 07/18/2023
Certification Date: 07/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11833 CALLE REY ALFONSO X
RIO GRANDE PR
00745-5208
US

IV. Provider business mailing address

11833 CALLE REY ALFONSO X
RIO GRANDE PR
00745-5208
US

V. Phone/Fax

Practice location:
  • Phone: 787-629-3528
  • Fax:
Mailing address:
  • Phone: 787-629-3528
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: