Provider Demographics
NPI:1033211289
Name:RODRIGUEZ MOJICA, WILMA (MD)
Entity Type:Individual
Prefix:DR
First Name:WILMA
Middle Name:
Last Name:RODRIGUEZ MOJICA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:FERNANDEZ STREET NO. 6 , THIRD FLOOR
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00918-4411
Mailing Address - Country:US
Mailing Address - Phone:787-763-6336
Mailing Address - Fax:787-763-6207
Practice Address - Street 1:FERNANDEZ STREET NO. 6 , THIRD FLOOR
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00918-4411
Practice Address - Country:US
Practice Address - Phone:787-763-6336
Practice Address - Fax:787-763-6207
Is Sole Proprietor?:No
Enumeration Date:2006-09-01
Last Update Date:2011-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR37892085R0202X, 2085U0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Ultrasound
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR25434OtherTRIPLE S
PR25434OtherTRIPLE S
PR0026118BMedicare ID - Type Unspecified