Provider Demographics
NPI:1174796015
Name:RODRIGUEZ, ROSA MARIAN (MD)
Entity type:Individual
Prefix:
First Name:ROSA
Middle Name:MARIAN
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:PO BOX 11878
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00922-1878
Mailing Address - Country:US
Mailing Address - Phone:787-765-0615
Mailing Address - Fax:787-759-7315
Practice Address - Street 1:CALLE CASIA ESQ. MAGA
Practice Address - Street 2:REPARTO METROPOLITANO
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00926
Practice Address - Country:US
Practice Address - Phone:787-765-0615
Practice Address - Fax:787-759-7315
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-11
Last Update Date:2008-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR10238173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes173000000XOther Service ProvidersLegal Medicine