Provider Demographics
NPI:1124084173
Name:RODRIGUEZ, EVELYN JUDITH (MD)
Entity type:Individual
Prefix:MISS
First Name:EVELYN
Middle Name:JUDITH
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:HC 71 BOX 1475
Mailing Address - Street 2:
Mailing Address - City:NARANJITO
Mailing Address - State:PR
Mailing Address - Zip Code:00719-9800
Mailing Address - Country:US
Mailing Address - Phone:787-638-3398
Mailing Address - Fax:787-739-5099
Practice Address - Street 1:3 CALLE FRANCISCO CRUZ
Practice Address - Street 2:
Practice Address - City:CIDRA
Practice Address - State:PR
Practice Address - Zip Code:00739-3419
Practice Address - Country:US
Practice Address - Phone:787-739-5099
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-26
Last Update Date:2012-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR14988171100000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No171100000XOther Service ProvidersAcupuncturist