Provider Demographics
NPI:1225088388
Name:RODRIGUEZ ORTIZ, LYDIA (MD)
Entity Type:Individual
Prefix:
First Name:LYDIA
Middle Name:
Last Name:RODRIGUEZ ORTIZ
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:PO BOX 8879
Mailing Address - Street 2:
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00988-8879
Mailing Address - Country:US
Mailing Address - Phone:787-758-5635
Mailing Address - Fax:787-764-1809
Practice Address - Street 1:505 AVE HOSTOS
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00918-3201
Practice Address - Country:US
Practice Address - Phone:787-758-5635
Practice Address - Fax:787-764-1809
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2023-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR6852174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRC79684Medicare UPIN
PR27645Medicare ID - Type Unspecified