Provider Demographics
NPI:1922459270
Name:OSORIO-RODRIGUEZ, MICHELLE
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:OSORIO-RODRIGUEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8511 MYSLAK WAY UNIT 2229
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32526-7895
Mailing Address - Country:US
Mailing Address - Phone:813-998-5990
Mailing Address - Fax:
Practice Address - Street 1:65 AVENIDA DE INFANTERIA
Practice Address - Street 2:HOSPITAL UPR DOCTOR FEDERICO TRILLA
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00984
Practice Address - Country:US
Practice Address - Phone:407-404-2595
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-28
Last Update Date:2021-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NY30536701207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program