Provider Demographics
NPI:1649231432
Name:RODRIGUEZ-GONZALEZ, VANESSA E (MD)
Entity Type:Individual
Prefix:DR
First Name:VANESSA
Middle Name:E
Last Name:RODRIGUEZ-GONZALEZ
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 1:139 CALLE MIMOSA
Mailing Address - Street 2:SANTA MARIA
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00927-6215
Mailing Address - Country:US
Mailing Address - Phone:787-765-1630
Mailing Address - Fax:787-756-6957
Practice Address - Street 1:139 CALLE MIMOSA
Practice Address - Street 2:SANTA MARIA
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00927-6215
Practice Address - Country:US
Practice Address - Phone:787-765-1630
Practice Address - Fax:787-756-6957
Is Sole Proprietor?:No
Enumeration Date:2006-03-31
Last Update Date:2009-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR11896207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRG44346Medicare UPIN
PR8-8903Medicare ID - Type UnspecifiedMEDICARE NUMBER