Provider Demographics
NPI:1245766492
Name:RODRIGUEZ-GARCIA, LYD-MARIE (MD)
Entity Type:Individual
Prefix:
First Name:LYD-MARIE
Middle Name:
Last Name:RODRIGUEZ-GARCIA
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:DD24 CALLE MONTANAS
Mailing Address - Street 2:
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00961-3301
Mailing Address - Country:US
Mailing Address - Phone:787-504-9879
Mailing Address - Fax:
Practice Address - Street 1:JESUS T PINERO BUILDING FERNANDEZ JUNCOS AVE
Practice Address - Street 2:BO PUEBLO
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00979
Practice Address - Country:US
Practice Address - Phone:787-626-3322
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-10
Last Update Date:2021-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR22238207R00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine