Provider Demographics
NPI:1609989557
Name:RODRIGUEZ, IVONNE ESTHER (MD)
Entity Type:Individual
Prefix:
First Name:IVONNE
Middle Name:ESTHER
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:IVONNE
Other - Middle Name:ESTHER
Other - Last Name:RODRIGUEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1683-1 CALLE PORTUGUES
Mailing Address - Street 2:RIO PIEDRAS HEIGHTS
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926-3117
Mailing Address - Country:US
Mailing Address - Phone:787-758-5074
Mailing Address - Fax:
Practice Address - Street 1:1683 CALLE PORTUGUES # 1
Practice Address - Street 2:RIO PIEDRAS HEIGHTS
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00926-3117
Practice Address - Country:US
Practice Address - Phone:787-758-5074
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR10142174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist