Provider Demographics
NPI:1942331210
Name:RODRIGUEZ, SILA IVELLISSE
Entity Type:Individual
Prefix:DR
First Name:SILA
Middle Name:IVELLISSE
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:DR
Other - First Name:SILA
Other - Middle Name:IVELLISSE
Other - Last Name:RODRIGUEZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:AVENUE LA SIERRA LA SIERRA DEL SOL
Mailing Address - Street 2:APT 151-J
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926
Mailing Address - Country:US
Mailing Address - Phone:787-224-0520
Mailing Address - Fax:
Practice Address - Street 1:255 AVE PONCE DE LEON MCS PLAZA PMB#154
Practice Address - Street 2:SUITE 75
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00917-1919
Practice Address - Country:US
Practice Address - Phone:787-758-2500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR13758208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice