Provider Demographics
NPI:1356872105
Name:RODRIGUEZ, NICOLE MARIE (MD)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:MARIE
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 1:225 CALLE VIOLETA
Mailing Address - Street 2:URB SAN FRANCISCO
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00927-6223
Mailing Address - Country:US
Mailing Address - Phone:787-484-2683
Mailing Address - Fax:
Practice Address - Street 1:225 CALLE VIOLETA
Practice Address - Street 2:URB SAN FRANCISCO
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00927-6223
Practice Address - Country:US
Practice Address - Phone:787-484-2683
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-23
Last Update Date:2021-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
FLME145434207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Single Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Single Specialty