Provider Demographics
NPI:1932178910
Name:RODRIGUEZ GUZMAN, WANDALIZ (MD)
Entity type:Individual
Prefix:DR
First Name:WANDALIZ
Middle Name:
Last Name:RODRIGUEZ GUZMAN
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 5164
Mailing Address - Street 2:
Mailing Address - City:AGUADILLA
Mailing Address - State:PUERTO RICO
Mailing Address - Zip Code:00605
Mailing Address - Country:UM
Mailing Address - Phone:787-243-6215
Mailing Address - Fax:787-243-6215
Practice Address - Street 1:CARR. 459, KM 3.9
Practice Address - Street 2:BO. CAMASEYES
Practice Address - City:AGUADILLA
Practice Address - State:PR
Practice Address - Zip Code:00603-6083
Practice Address - Country:US
Practice Address - Phone:787-243-6215
Practice Address - Fax:787-243-6215
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-14
Last Update Date:2014-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR13789171100000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR13789OtherPLAN MEDICO SSBV
PR84360OtherFIRST PLUS HEALTH PLAN OF PUERTO RICO
PR84360ROOtherTRIPLE-S, INC.
PR100915OtherLA CRUZ AZUL DE PUERTO RICO
PR60300089OtherHUMANA HEALTH PLAN
PR201978OtherPREFERRED HEALTH, INC.
PR8856OtherFIRST MEDICAL HEALTH PLAN / INTERNATIONAL MEDICAL CARD
PR84360OtherMEDICARE
PR$$$$$$$$$OtherMAPFRE MEDICARE EXCEL
PR60300089OtherHUMANA HEALTH PLAN
PR$$$$$$$$$OtherMAPFRE SALUD
PR8856OtherFIRST MEDICAL HEALTH PLAN / INTERNATIONAL MEDICAL CARD
PR84360ROOtherTRIPLE-S, INC.
PR8856OtherFIRST MEDICAL HEALTH PLAN / INTERNATIONAL MEDICAL CARD