Provider Demographics
NPI:1487744611
Name:RODRIGUEZ RODRIGUEZ, ROSELIS (MD)
Entity type:Individual
Prefix:
First Name:ROSELIS
Middle Name:
Last Name:RODRIGUEZ 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:PO BOX 1905
Mailing Address - Street 2:
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00984
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:AVE MONSERRATE BA-14
Practice Address - Street 2:VALLE ARRIBA HEIGHTS
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00984
Practice Address - Country:US
Practice Address - Phone:787-768-4720
Practice Address - Fax:787-768-4720
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2011-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR10362208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR3868OtherPREFERRED MEDICAL CHOICE
PR82882OtherTRIPLE S
PR826041OtherMEDICARE Y MUCHO MAS
PR02034OtherAMERICAN HEALTH
PR201595OtherPREFERRED HEALTH
PR069488OtherCRUZ AZUL
PR9600018OtherHUMANA
0082882Medicare ID - Type Unspecified