MEDICARE: LAURA E RODRIGUEZ RIVERA 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	208600000X	Surgery Physician	19591	PR

General Provider Information

NPI Number	:	1851656672
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAURA E RODRIGUEZ RIVERA M.D.

Provider Business Mailing Address
First Line	:	609 TITO CASTRO AVE
Second Line	:	SUITE 102 PMB 370
City	:	PONCE
State	:	PR
Zip	:	00716-0020
Country	:	US
Telephone Number	:	787-259-3355
Fax Number	:

Provider Business Practice Location Address
First Line	:	909 AVE TITO CASTRO
Second Line	:	SUITE 723 TORRE MEDICA SAN LUCAS
City	:	PONCE
State	:	PR
Zip	:	00716-4725
Country	:	US
Telephone Number	:	787-259-3355
Fax Number	:	787-844-3003

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

Provider Enumeration Date	:	07/09/2012
Last Update Date	:	07/21/2022

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