Provider Demographics
NPI:1669581625
Name:RODRIGUEZ, ALVILDA MARIA (OD)
Entity type:Individual
Prefix:DR
First Name:ALVILDA
Middle Name:MARIA
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:VA-PONCE OUTPATIENT CLINIC
Mailing Address - Street 2:1010 PASEO DEL VETERANO
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00716-2001
Mailing Address - Country:US
Mailing Address - Phone:787-812-3030
Mailing Address - Fax:787-651-4320
Practice Address - Street 1:PONCE OUTPATIENT CLINIC
Practice Address - Street 2:PASEO DEL VETERANO 1010
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00716-2001
Practice Address - Country:US
Practice Address - Phone:787-812-3030
Practice Address - Fax:787-651-4320
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2007-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR409152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist