Provider Demographics
NPI:1447396452
Name:RODRIGUEZ, MARIEM (OD)
Entity Type:Individual
Prefix:DR
First Name:MARIEM
Middle Name:
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 CALLE 65 INFANTERIA
Mailing Address - Street 2:STE 1
Mailing Address - City:ANASCO
Mailing Address - State:PR
Mailing Address - Zip Code:00610-2941
Mailing Address - Country:US
Mailing Address - Phone:787-826-6484
Mailing Address - Fax:787-826-0215
Practice Address - Street 1:PLAZA SALCEDO
Practice Address - Street 2:SUITE 104
Practice Address - City:ANASCO
Practice Address - State:PR
Practice Address - Zip Code:00610
Practice Address - Country:US
Practice Address - Phone:787-826-6484
Practice Address - Fax:787-826-0215
Is Sole Proprietor?:No
Enumeration Date:2007-01-29
Last Update Date:2016-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR507152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
U83312Medicare UPIN
PR59372Medicare ID - Type Unspecified