Healthcare Provider Details

I. General information

NPI: 1265765747
Provider Name (Legal Business Name): MICHELLE TULIER-RODRIGUEZ M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/15/2009
Last Update Date: 08/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

SAN JUAN CITY HOSPITAL CENTRO MEDICO PUERTO RICO
SAN JUAN PR
00936-8344
US

IV. Provider business mailing address

PO BOX 70344 PMB#498
SAN JUAN PR
00936-8344
US

V. Phone/Fax

Practice location:
  • Phone: 787-765-7618
  • Fax:
Mailing address:
  • Phone: 787-765-7618
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number28099
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: