Provider Demographics
NPI:1588647382
Name:RODRIGUEZ, ANATILA (MD)
Entity type:Individual
Prefix:MISS
First Name:ANATILA
Middle Name:
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:13 CALLE GUAYACAN
Mailing Address - Street 2:#19 SOL
Mailing Address - City:SAN GERMAN
Mailing Address - State:PR
Mailing Address - Zip Code:00683-9553
Mailing Address - Country:US
Mailing Address - Phone:787-643-6453
Mailing Address - Fax:787-892-2004
Practice Address - Street 1:CALLE SOL ESQUINA CONCEPCION #12
Practice Address - Street 2:
Practice Address - City:SAN GERMAN,
Practice Address - State:PR
Practice Address - Zip Code:00683
Practice Address - Country:US
Practice Address - Phone:787-892-2004
Practice Address - Fax:787-892-2004
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-25
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR006511207R00000X
PR6511207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR5361OtherFIRST MEDICAL
PRPE1426OtherPALIC
PR067382OtherCRUZ AZUL
PR14743OtherPREFERED HEALTH
PR19255025OtherPROSSAM
PR1496OtherPREFERED MEDICARE CHOICE
PR7530006OtherHUMANA
PR80843ROOtherTRIPLE SSS
PR1108328OtherACAA
PR80843ROOtherTRIPLE SSS
PR067382OtherCRUZ AZUL
PR1496OtherPREFERED MEDICARE CHOICE
PR1496Medicare UPIN