Provider Demographics
NPI:1275128795
Name:RODRIGUEZ, JOAN MARIE (MD)
Entity Type:Individual
Prefix:
First Name:JOAN
Middle Name:MARIE
Last Name: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 1:5153 AVE RAMON RIOS
Mailing Address - Street 2:
Mailing Address - City:SABANA SECA
Mailing Address - State:PR
Mailing Address - Zip Code:00952-4250
Mailing Address - Country:US
Mailing Address - Phone:939-322-8688
Mailing Address - Fax:
Practice Address - Street 1:5153 AVE RAMON RIOS
Practice Address - Street 2:
Practice Address - City:SABANA SECA
Practice Address - State:PR
Practice Address - Zip Code:00952-4250
Practice Address - Country:US
Practice Address - Phone:939-322-8688
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-05
Last Update Date:2023-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR23150208D00000X, 208D00000X
PR16058-I390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR23150OtherMD
PR16058-IOtherMD
PR23150OtherMD