Provider Demographics
NPI:1205860731
Name:RODRIGUEZ, WILFREDO (MD)
Entity Type:Individual
Prefix:DR
First Name:WILFREDO
Middle Name:
Last Name:RODRIGUEZ
Suffix:
Gender:M
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:BOSQUE DE LAS PALMAS 196
Mailing Address - Street 2:COCO PLUMOROSO
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00956-9250
Mailing Address - Country:US
Mailing Address - Phone:178-755-1935
Mailing Address - Fax:787-799-0007
Practice Address - Street 1:URBANIZACION ROYAL GARDENS CARR. #167
Practice Address - Street 2:ROYAL GARDENS SHOPPING CENTER
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00957
Practice Address - Country:US
Practice Address - Phone:787-799-0007
Practice Address - Fax:787-799-0007
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-10
Last Update Date:2013-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR14963208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRI25547Medicare UPIN