Provider Demographics
NPI:1912485541
Name:VIDAL RODRIGUEZ, JOANN ALEXANDRA I (MD)
Entity Type:Individual
Prefix:MISS
First Name:JOANN
Middle Name:ALEXANDRA
Last Name:VIDAL RODRIGUEZ
Suffix:I
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 1606
Mailing Address - Street 2:
Mailing Address - City:HORMIGUEROS
Mailing Address - State:PR
Mailing Address - Zip Code:00660
Mailing Address - Country:US
Mailing Address - Phone:787-384-5118
Mailing Address - Fax:
Practice Address - Street 1:CARRETERA 2 KM 173.4
Practice Address - Street 2:
Practice Address - City:SAN GERMAN
Practice Address - State:PR
Practice Address - Zip Code:00683-0285
Practice Address - Country:US
Practice Address - Phone:787-892-1860
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-06
Last Update Date:2018-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR33910-R207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty