Provider Demographics
NPI:1093918179
Name:RODRIGUEZ, VILMARIE (MD)
Entity Type:Individual
Prefix:DR
First Name:VILMARIE
Middle Name:
Last Name:RODRIGUEZ
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 74 BOX 5697
Mailing Address - Street 2:BARRIO GUADIANA
Mailing Address - City:NARANJITO
Mailing Address - State:PR
Mailing Address - Zip Code:00719-7491
Mailing Address - Country:US
Mailing Address - Phone:787-869-6494
Mailing Address - Fax:
Practice Address - Street 1:CARR 167 KM 11 0
Practice Address - Street 2:BO DAJAOS
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00956
Practice Address - Country:US
Practice Address - Phone:787-730-3446
Practice Address - Fax:787-730-3446
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR15192208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR500503EOtherMEDICARE MUCHO MAS
PR22662ROOtherTRIPLE SSS
PR4210OtherPMC MEDICARE CHOICE
PR9500838OtherLA CRUZ AZUL DE PUERTO RI
PR4210OtherPMC MEDICARE CHOICE
PRI20620Medicare UPIN