Provider Demographics
NPI:1194768150
Name:RODRIGUEZ, GLENDA MILAGROS (MD)
Entity type:Individual
Prefix:DR
First Name:GLENDA
Middle Name:MILAGROS
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 1:81 CALLE 4
Mailing Address - Street 2:
Mailing Address - City:JUANA DIAZ
Mailing Address - State:PR
Mailing Address - Zip Code:00795-1513
Mailing Address - Country:US
Mailing Address - Phone:787-299-7981
Mailing Address - Fax:787-837-3198
Practice Address - Street 1:CARRION MADURO STREET
Practice Address - Street 2:#31
Practice Address - City:JUANA DIAZ
Practice Address - State:PR
Practice Address - Zip Code:00795
Practice Address - Country:US
Practice Address - Phone:787-837-6412
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2013-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR14919208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice