Provider Demographics
NPI:1255508891
Name:RODRIGUEZ COSS, MARIELLY (MD)
Entity Type:Individual
Prefix:DR
First Name:MARIELLY
Middle Name:
Last Name:RODRIGUEZ COSS
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:LAS LEANDRAS STATION
Mailing Address - Street 2:PMB100 R20 C3
Mailing Address - City:HUMACAO
Mailing Address - State:PR
Mailing Address - Zip Code:00791-3007
Mailing Address - Country:US
Mailing Address - Phone:787-479-9883
Mailing Address - Fax:787-850-6398
Practice Address - Street 1:URB. LAS LEANDRAS
Practice Address - Street 2:CALLE#3 R-20
Practice Address - City:HUMACAO
Practice Address - State:PR
Practice Address - Zip Code:00791
Practice Address - Country:US
Practice Address - Phone:787-479-9883
Practice Address - Fax:787-850-6398
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-13
Last Update Date:2008-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR17124208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice