Provider Demographics
NPI:1821079070
Name:RODRIGUEZ VARGAS, DINAMARCA (MD)
Entity Type:Individual
Prefix:
First Name:DINAMARCA
Middle Name:
Last Name:RODRIGUEZ VARGAS
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 19536
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00910-1536
Mailing Address - Country:US
Mailing Address - Phone:787-977-0707
Mailing Address - Fax:787-977-0708
Practice Address - Street 1:FIRST BANK BLDG 1519
Practice Address - Street 2:AVE PONCE DE LEON STE 1101 P/23 SANTURCE
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00910-9536
Practice Address - Country:US
Practice Address - Phone:787-977-0707
Practice Address - Fax:787-977-0708
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-07
Last Update Date:2016-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR12901207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
21250Medicare ID - Type Unspecified
H75685Medicare UPIN