Provider Demographics
NPI:1700841400
Name:RODRIGUEZ JUARBE, MARY ANN (MD)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:ANN
Last Name:RODRIGUEZ JUARBE
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 1:154 EBANO
Mailing Address - Street 2:GOLDEN GATE
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00968
Mailing Address - Country:US
Mailing Address - Phone:787-781-7561
Mailing Address - Fax:787-273-1260
Practice Address - Street 1:1588 AVE JT PINERO
Practice Address - Street 2:CAPARRA TERRACE
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00921-1413
Practice Address - Country:US
Practice Address - Phone:787-781-7561
Practice Address - Fax:787-273-1260
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4490207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
25718Medicare ID - Type Unspecified
E31167Medicare UPIN