Provider Demographics
NPI:1619023314
Name:RODRIGUEZ, MIGDALIA (MD)
Entity Type:Individual
Prefix:
First Name:MIGDALIA
Middle Name:
Last Name:RODRIGUEZ
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:PO BOX 312
Mailing Address - Street 2:
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00986-0312
Mailing Address - Country:US
Mailing Address - Phone:787-762-2380
Mailing Address - Fax:787-276-9687
Practice Address - Street 1:SANCHEZ OSORIO AVE 5A3 VILLA FONTANA
Practice Address - Street 2:
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00983
Practice Address - Country:US
Practice Address - Phone:787-762-2380
Practice Address - Fax:787-276-9687
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR13981208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0020805Medicare ID - Type UnspecifiedPROVIDER NUMBER