Provider Demographics
NPI:1942564794
Name:MEDERO-RODRIGUEZ, PRISCILLA MARIE (MD)
Entity Type:Individual
Prefix:DR
First Name:PRISCILLA
Middle Name:MARIE
Last Name:MEDERO-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 3456
Mailing Address - Street 2:
Mailing Address - City:MAYAGUEZ
Mailing Address - State:PR
Mailing Address - Zip Code:00681-3456
Mailing Address - Country:US
Mailing Address - Phone:787-827-8076
Mailing Address - Fax:
Practice Address - Street 1:349 AVE HOSTOS EDIF OFFICE PARK 1
Practice Address - Street 2:SUITE 201
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00680-3456
Practice Address - Country:US
Practice Address - Phone:787-827-8076
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-26
Last Update Date:2024-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR19556207RG0100X
MI4301501900207RG0100X
PR31642-R208D00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Single Specialty