Basic Information
| Provider Information | |||||||||
| NPI: | 1619023314 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RODRIGUEZ | ||||||||
| FirstName: | MIGDALIA | ||||||||
| MiddleName: | |||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 312 | ||||||||
| Address2: | |||||||||
| City: | CAROLINA | ||||||||
| State: | PR | ||||||||
| PostalCode: | 009860312 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7877622380 | ||||||||
| FaxNumber: | 7872769687 | ||||||||
| Practice Location | |||||||||
| Address1: | SANCHEZ OSORIO AVE 5A3 VILLA FONTANA | ||||||||
| Address2: | |||||||||
| City: | CAROLINA | ||||||||
| State: | PR | ||||||||
| PostalCode: | 00983 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7877622380 | ||||||||
| FaxNumber: | 7872769687 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/26/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208D00000X | 13981 | PR | Y | Allopathic & Osteopathic Physicians | General Practice |
No ID Information.