Provider Demographics
NPI:1184796393
Name:RODRIGUEZ, MARIA DE LOS ANGELES (MD)
Entity type:Individual
Prefix:DR
First Name:MARIA
Middle Name:DE LOS ANGELES
Last Name: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:CAMPO LAGO #45
Mailing Address - Street 2:CALLE PALMAS A 15
Mailing Address - City:CIDRA
Mailing Address - State:PR
Mailing Address - Zip Code:00739
Mailing Address - Country:US
Mailing Address - Phone:787-743-7863
Mailing Address - Fax:787-743-7863
Practice Address - Street 1:EDIF. LA SIERRA
Practice Address - Street 2:CARR. 172 KM6.2
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725
Practice Address - Country:US
Practice Address - Phone:787-743-7863
Practice Address - Fax:787-743-7863
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR13367208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRH35857Medicare UPIN