MEDICARE: VIVIAN J. RODRIGUEZ M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	10157	PR

General Provider Information

NPI Number	:	1811934466
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VIVIAN J. RODRIGUEZ M.D.

Provider Business Mailing Address
First Line	:	E5 CALLE SAN ONOFRE
Second Line	:	URB. MARIOLGA
City	:	CAGUAS
State	:	PR
Zip	:	00725-6405
Country	:	US
Telephone Number	:	787-344-1366
Fax Number	:

Provider Business Practice Location Address
First Line	:	2 CALLE MUNOZ RIVERA
Second Line	:
City	:	CAGUAS
State	:	PR
Zip	:	00725-2603
Country	:	US
Telephone Number	:	787-344-1366
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/01/2006
Last Update Date	:	04/28/2014

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