Healthcare Provider Details

I. General information

NPI: 1598843153
Provider Name (Legal Business Name): ROSA ADELAIDA RODRIGUEZ M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

66 CALLE GEORGETTI STE 202
SAN JUAN PR
00925-3607
US

IV. Provider business mailing address

PO BOX 362334
SAN JUAN PR
00936-2334
US

V. Phone/Fax

Practice location:
  • Phone: 787-751-0715
  • Fax: 787-751-0435
Mailing address:
  • Phone: 787-751-0715
  • Fax: 787-751-0435

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number5430
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: