Provider Demographics
NPI:1275675175
Name:RODRIGUEZ RIVERA, ADA (MD)
Entity Type:Individual
Prefix:
First Name:ADA
Middle Name:
Last Name:RODRIGUEZ RIVERA
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 364944
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00936-4944
Mailing Address - Country:US
Mailing Address - Phone:787-365-1891
Mailing Address - Fax:787-273-1848
Practice Address - Street 1:CARR #2 KM 8 5
Practice Address - Street 2:BO JUAN SANCHEZ
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00960-0248
Practice Address - Country:US
Practice Address - Phone:787-782-8250
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR10419208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation