Provider Demographics
NPI:1912002361
Name:ALICEA-RODRIGUEZ, MIRIAM NOELIA (MD)
Entity Type:Individual
Prefix:MISS
First Name:MIRIAM
Middle Name:NOELIA
Last Name:ALICEA-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:PO BOX 9001
Mailing Address - Street 2:
Mailing Address - City:HUMACAO
Mailing Address - State:PR
Mailing Address - Zip Code:00792-9001
Mailing Address - Country:US
Mailing Address - Phone:787-850-7950
Mailing Address - Fax:787-285-8026
Practice Address - Street 1:CALLE MUNOZ MARIN
Practice Address - Street 2:ESQ MIGUEL CASILLAS #50
Practice Address - City:HUMACAO
Practice Address - State:PR
Practice Address - Zip Code:00791
Practice Address - Country:US
Practice Address - Phone:787-850-7950
Practice Address - Fax:787-285-8026
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR64762080P0205X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0205XAllopathic & Osteopathic PhysiciansPediatricsPediatric Endocrinology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR06998DM9OtherLOCAL NARCOTIC LICENSE
AA3232446OtherFED NARCOTIC LICENSE
PR6476OtherMEDICAL LICENSE