Provider Demographics
NPI:1346552148
Name:RODRIGUEZ, VIRGINCITA FUENTES (MD)
Entity Type:Individual
Prefix:DR
First Name:VIRGINCITA
Middle Name:FUENTES
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:VIRGINCITA
Other - Middle Name:FERRY
Other - Last Name:FUENTES-RODRIGUEZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:2000 MCLAIN ST STE B
Mailing Address - Street 2:
Mailing Address - City:NEWPORT
Mailing Address - State:AR
Mailing Address - Zip Code:72112-3661
Mailing Address - Country:US
Mailing Address - Phone:870-523-7563
Mailing Address - Fax:870-523-2407
Practice Address - Street 1:2000 MCLAIN ST STE B
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:AR
Practice Address - Zip Code:72112-3661
Practice Address - Country:US
Practice Address - Phone:870-523-7563
Practice Address - Fax:870-523-2407
Is Sole Proprietor?:No
Enumeration Date:2010-07-08
Last Update Date:2020-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE-7959207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine