Provider Demographics
NPI:1023234424
Name:RODRIGUEZ - MUNOZ, DIANA H (MD)
Entity type:Individual
Prefix:DR
First Name:DIANA
Middle Name:H
Last Name:RODRIGUEZ - MUNOZ
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:URB RIO PIEDRAS HEIGHTS
Mailing Address - Street 2:209 CALLE BISTULA
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926
Mailing Address - Country:US
Mailing Address - Phone:787-763-6196
Mailing Address - Fax:
Practice Address - Street 1:URB RIO PIEDRAS HEIGHTS
Practice Address - Street 2:209 CALLE BISTULA
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00926
Practice Address - Country:US
Practice Address - Phone:787-763-6196
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-17
Last Update Date:2012-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR7088207P00000X, 207Q00000X
MI4301064743207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR28466OtherTRIPLE-S PROVIDER ID
PR3313658Medicaid
PRDR064743OtherBLUE CROSS BLUE SHIELD
PR28466OtherTRIPLE-S PROVIDER ID
PRDR064743OtherBLUE CROSS BLUE SHIELD