Provider Demographics
NPI:1710019146
Name:RODRIGUEZ-POVENTUD, JULIE ROSE (MD)
Entity Type:Individual
Prefix:DR
First Name:JULIE
Middle Name:ROSE
Last Name:RODRIGUEZ-POVENTUD
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:N3 CALLE UN
Mailing Address - Street 2:GARDEN HILLS - NORTH
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00966-2124
Mailing Address - Country:US
Mailing Address - Phone:787-782-0459
Mailing Address - Fax:
Practice Address - Street 1:N3 CALLE UN
Practice Address - Street 2:GARDEN HILLS - NORTH
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00966-2124
Practice Address - Country:US
Practice Address - Phone:787-782-0459
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR6461207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR98166Medicare ID - Type UnspecifiedMEDICARE PROVIDER