Healthcare Provider Details

I. General information

NPI: 1265487490
Provider Name (Legal Business Name): ZOE M. RODRIGUEZ MD
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/24/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

DEPARTMENT OF PEDIATRICS UPR SCHOOL OF MEDICINE FIRST FLOOR, OFFICE A1-29 UNIVERSITY PEDIATRIC HOSPITAL
SAN JUAN PR
00935
US

IV. Provider business mailing address

PO BOX 140430
ARECIBO PR
00614-0430
US

V. Phone/Fax

Practice location:
  • Phone: 787-756-4020
  • Fax: 787-777-3227
Mailing address:
  • Phone: 787-756-4010
  • Fax: 787-817-1502

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0208X
TaxonomyPediatric Infectious Diseases Physician
License Number12,680
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: