Provider Demographics
NPI:1891026555
Name:LA SALLE RODRIGUEZ, MARINAIDA (MD)
Entity Type:Individual
Prefix:
First Name:MARINAIDA
Middle Name:
Last Name:LA SALLE RODRIGUEZ
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 1:65 CALLE CAPESTANY
Mailing Address - Street 2:APT. 1
Mailing Address - City:MAYAGUEZ
Mailing Address - State:PR
Mailing Address - Zip Code:00680-4049
Mailing Address - Country:US
Mailing Address - Phone:787-435-5582
Mailing Address - Fax:
Practice Address - Street 1:49 CALLE MUNOZ RIVERA
Practice Address - Street 2:
Practice Address - City:JUNCOS
Practice Address - State:PR
Practice Address - Zip Code:00777-3112
Practice Address - Country:US
Practice Address - Phone:787-435-5582
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-20
Last Update Date:2018-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR17797208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR17797OtherJUNTA DE LICENCIAMIENTO Y DISCIPLINA MEDICA DE PUERTO RICO (LICENSE)
PR80011OtherJUNTA DE LICENCIAMIENTO Y DISCIPLINA MEDICA DE PUERTO RICO (REGISTRY)
PRDM-17668-5OtherASSMCA
PR17797OtherCOLEGIO DE MEDICOS DE PUERTO RICO