Healthcare Provider Details

I. General information

NPI: 1548464811
Provider Name (Legal Business Name): MARIMIE RODRIGUEZ-CAMPOS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/12/2007
Last Update Date: 03/23/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 CALLE CASIA DEPT PMR
SAN JUAN PR
00921-3200
US

IV. Provider business mailing address

400-315 CALLE UNION MAGGIORE
GUAYNABO PR
00969
US

V. Phone/Fax

Practice location:
  • Phone: 787-641-7582
  • Fax:
Mailing address:
  • Phone: 787-380-9776
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number16082
License Number StatePR
# 2
Primary TaxonomyN
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number16082
License Number StatePR
# 3
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number16082
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: