Provider Demographics
NPI:1891722351
Name:RODRIGUEZ-GALARZA, WANDA LIZ (MD)
Entity Type:Individual
Prefix:DR
First Name:WANDA
Middle Name:LIZ
Last Name:RODRIGUEZ-GALARZA
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 1:1503 MARBELLA ST.
Mailing Address - Street 2:MANSIONES VISTAMAR MARINA
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00983
Mailing Address - Country:US
Mailing Address - Phone:787-257-9586
Mailing Address - Fax:787-257-9586
Practice Address - Street 1:1503 MARBELLA ST.
Practice Address - Street 2:MANSIONES VISTAMAR MARINA
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00983
Practice Address - Country:US
Practice Address - Phone:787-257-9586
Practice Address - Fax:787-257-9586
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR120892085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR89856Medicare ID - Type Unspecified