Provider Demographics
NPI:1235109687
Name:DEL RIO RODRIGUEZ, IRAIDA (MD)
Entity Type:Individual
Prefix:DR
First Name:IRAIDA
Middle Name:
Last Name:DEL RIO 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:PO BOX 336149
Mailing Address - Street 2:
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00733-6149
Mailing Address - Country:US
Mailing Address - Phone:787-844-0331
Mailing Address - Fax:787-840-8874
Practice Address - Street 1:607 CALLE FERROCARRIL
Practice Address - Street 2:ESQUINA TORRES
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00717-6149
Practice Address - Country:US
Practice Address - Phone:787-259-7219
Practice Address - Fax:787-840-8874
Is Sole Proprietor?:No
Enumeration Date:2006-01-26
Last Update Date:2017-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR9369207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRE66623Medicare UPIN