Provider Demographics
NPI:1124135785
Name:NAZARIO-RODRIGUEZ, ANGEL D (MD)
Entity type:Individual
Prefix:
First Name:ANGEL
Middle Name:D
Last Name:NAZARIO-RODRIGUEZ
Suffix:
Gender:M
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 1775
Mailing Address - Street 2:
Mailing Address - City:CIDRA
Mailing Address - State:PR
Mailing Address - Zip Code:00739-1775
Mailing Address - Country:US
Mailing Address - Phone:787-738-9938
Mailing Address - Fax:787-738-9939
Practice Address - Street 1:CARR 14 INTERIOR KM 0.3
Practice Address - Street 2:CENTRO MEDICO MENONITA EDIFICIO PROFESIONAL SUITE 311
Practice Address - City:CAYEY
Practice Address - State:PR
Practice Address - Zip Code:00736
Practice Address - Country:US
Practice Address - Phone:787-738-9938
Practice Address - Fax:787-738-9939
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-23
Last Update Date:2018-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR14850207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRHS552ZMedicare PIN