Provider Demographics
NPI:1205944832
Name:RODRIGUEZ, GRISEL (MD)
Entity type:Individual
Prefix:MISS
First Name:GRISEL
Middle Name:
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:VILLAS DE MONTECARLOS II CALLE B
Mailing Address - Street 2:APT 1003
Mailing Address - City:RIOS PIEDRA
Mailing Address - State:PR
Mailing Address - Zip Code:00924-4122
Mailing Address - Country:US
Mailing Address - Phone:787-768-5499
Mailing Address - Fax:787-768-5499
Practice Address - Street 1:VILLAS DE MONTECARLOS II CALLE B
Practice Address - Street 2:APT 1003
Practice Address - City:RIOS PIEDRA
Practice Address - State:PR
Practice Address - Zip Code:00924-4122
Practice Address - Country:US
Practice Address - Phone:787-768-5499
Practice Address - Fax:787-768-5499
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR15415208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRI27848Medicare UPIN
PR0022753Medicare ID - Type Unspecified