Provider Demographics
NPI:1063015311
Name:RODRIGUEZ RIVERA, NADYA NOEMI (MD)
Entity Type:Individual
Prefix:DR
First Name:NADYA
Middle Name:NOEMI
Last Name:RODRIGUEZ RIVERA
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:HC 2 BOX 14533
Mailing Address - Street 2:
Mailing Address - City:GUAYANILLA
Mailing Address - State:PR
Mailing Address - Zip Code:00656-9827
Mailing Address - Country:US
Mailing Address - Phone:787-420-4281
Mailing Address - Fax:
Practice Address - Street 1:2225 PONCE BY PASS
Practice Address - Street 2:PARRA MEDICAL PLAZA 905
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00717
Practice Address - Country:US
Practice Address - Phone:787-844-2710
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-19
Last Update Date:2023-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR195-P.A.363AM0700X
PR22590208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical