Healthcare Provider Details

I. General information

NPI: 1861700841
Provider Name (Legal Business Name): GLORIA IVETTE RODRIGUEZ-CUADRADO M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/23/2010
Last Update Date: 03/21/2024
Certification Date: 03/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

257 CALLE DE TETUAN
SAN JUAN PR
00901-2039
US

IV. Provider business mailing address

PO BOX 9023895
SAN JUAN PR
00902-3895
US

V. Phone/Fax

Practice location:
  • Phone: 787-822-8623
  • Fax: 425-250-8291
Mailing address:
  • Phone: 787-822-8623
  • Fax: 425-250-8291

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207UN0902X
TaxonomyNuclear Imaging & Therapy Physician
License Number18548
License Number StatePR
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberA131486
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number34159
License Number StateOK
# 4
Primary TaxonomyN
Taxonomy Code207U00000X
TaxonomyNuclear Medicine Physician
License Number18548
License Number StatePR
# 5
Primary TaxonomyN
Taxonomy Code207UN0902X
TaxonomyNuclear Imaging & Therapy Physician
License NumberA131486
License Number StateCA
# 6
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number18548
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: