Provider Demographics
NPI:1669556395
Name:RODRIGUEZ RIVERA, NATIVIDAD (MD)
Entity type:Individual
Prefix:
First Name:NATIVIDAD
Middle Name:
Last Name:RODRIGUEZ RIVERA
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 366294
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00936-6294
Mailing Address - Country:US
Mailing Address - Phone:787-751-5955
Mailing Address - Fax:787-767-0516
Practice Address - Street 1:LODI STREET A2
Practice Address - Street 2:VILLA LUARCA
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00924-0000
Practice Address - Country:US
Practice Address - Phone:787-751-5955
Practice Address - Fax:787-767-0516
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR48932084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry