Provider Demographics
NPI:1326242918
Name:RODRIGUEZ GUILLOTY, NICOLE MARIEL (MD, FACS)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:MARIEL
Last Name:RODRIGUEZ GUILLOTY
Suffix:
Gender:F
Credentials:MD, FACS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 368090
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00936-8090
Mailing Address - Country:US
Mailing Address - Phone:787-550-5054
Mailing Address - Fax:787-250-3501
Practice Address - Street 1:400 F.D. ROOSEVELT AVE.
Practice Address - Street 2:SUITE 507
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00918
Practice Address - Country:US
Practice Address - Phone:787-250-3500
Practice Address - Fax:787-250-3501
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-14
Last Update Date:2014-11-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PR17980208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery