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General NPI Number Information
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NPI Number | 1407242548
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Entity Type | Individual
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Provider Name | JUAN VITELIO RODRIGUEZ MD
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Gender | Male
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Dates
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Enumeration Date | 04/15/2015
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 20 YORK ST
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City | NEW HAVEN
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State | CT
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Zip | 06510-3220
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Country | US
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Telephone | 203-688-4242
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Fax |
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Provider Business Mailing Address
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Address Line | 12436 N SANDBY GREEN DR
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City | MARANA
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State | AZ
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Zip | 85653-8970
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Country | US
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Telephone | 619-709-4848
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207ZC0006X
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Taxonomy Name | Clinical Pathology Physician
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License Number | T9025
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License Number State | TX
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