Provider Demographics
NPI:1982679726
Name:RODRIGUEZ, NITZA (MD)
Entity Type:Individual
Prefix:DR
First Name:NITZA
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:MANUEL CHELO ROMAN ST
Mailing Address - Street 2:# 48
Mailing Address - City:ADJUNTAS
Mailing Address - State:PR
Mailing Address - Zip Code:00601
Mailing Address - Country:US
Mailing Address - Phone:787-391-8076
Mailing Address - Fax:787-840-9708
Practice Address - Street 1:COLISEO SHOPPING CENTER - AVENIDA EDUARDO RUBERTE
Practice Address - Street 2:SUITE 103
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00728-1712
Practice Address - Country:US
Practice Address - Phone:787-840-9708
Practice Address - Fax:787-840-9708
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-22
Last Update Date:2020-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR13924207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR13924OtherMEDICAL LICENSE