Provider Demographics
NPI:1639153679
Name:RODRIGUEZ-HERNANDEZ, MARISOL (MD)
Entity Type:Individual
Prefix:DR
First Name:MARISOL
Middle Name:
Last Name:RODRIGUEZ-HERNANDEZ
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 191625
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00919-1625
Mailing Address - Country:US
Mailing Address - Phone:787-774-5555
Mailing Address - Fax:787-774-5767
Practice Address - Street 1:1785 CARR 21
Practice Address - Street 2:SUITE 95
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00921-3399
Practice Address - Country:US
Practice Address - Phone:787-774-5555
Practice Address - Fax:787-774-5767
Is Sole Proprietor?:No
Enumeration Date:2005-12-02
Last Update Date:2016-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR74112085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR85063OtherPROVIDER NUMBER, OFFICE AT AGUADILLA, PR
PR20931Medicare ID - Type UnspecifiedOFFICE IN MANATI, PR
PRC77709Medicare UPIN
PR20271Medicare ID - Type UnspecifiedOFFICE IN SAN JUAN, PR