Provider Demographics
NPI:1932187697
Name:RODRIGUEZ DELGADO, ILEANA C (MD)
Entity type:Individual
Prefix:MRS
First Name:ILEANA
Middle Name:C
Last Name:RODRIGUEZ DELGADO
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 3762
Mailing Address - Street 2:
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00984-3762
Mailing Address - Country:US
Mailing Address - Phone:787-752-7897
Mailing Address - Fax:787-758-0589
Practice Address - Street 1:AVE CAMPO RICO A6
Practice Address - Street 2:CASTELLANO GALVEZ
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00983
Practice Address - Country:US
Practice Address - Phone:787-752-7897
Practice Address - Fax:787-768-0689
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-04
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR14398208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR21420Medicare ID - Type Unspecified
H96746Medicare UPIN