Provider Demographics
NPI:1508034562
Name:RODRIGUEZ VILLEGAS, GLORISEL (MD)
Entity Type:Individual
Prefix:
First Name:GLORISEL
Middle Name:
Last Name:RODRIGUEZ VILLEGAS
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 1:127 WILDOT DR
Mailing Address - Street 2:
Mailing Address - City:STATE COLLEGE
Mailing Address - State:PA
Mailing Address - Zip Code:16801-7818
Mailing Address - Country:US
Mailing Address - Phone:516-984-3988
Mailing Address - Fax:814-940-8516
Practice Address - Street 1:300 E WALNUT AVE
Practice Address - Street 2:
Practice Address - City:ALTOONA
Practice Address - State:PA
Practice Address - Zip Code:16601-5210
Practice Address - Country:US
Practice Address - Phone:814-943-1272
Practice Address - Fax:814-940-8516
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-13
Last Update Date:2011-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD438515208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation