Provider Demographics
NPI:1255807764
Name:ALICEA RODRIGUEZ, ISAMAR (MEDICAL STUDENT)
Entity type:Individual
Prefix:
First Name:ISAMAR
Middle Name:
Last Name:ALICEA RODRIGUEZ
Suffix:
Gender:F
Credentials:MEDICAL STUDENT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:URB REPARTO LANDRAU COND PORTAL URBANO
Mailing Address - Street 2:1456 CALLE FRASER APT 3
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00921
Mailing Address - Country:US
Mailing Address - Phone:787-408-9494
Mailing Address - Fax:
Practice Address - Street 1:CARRETERA 3 KM 8.3
Practice Address - Street 2:AVE 65 DE INFANTERIA
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00984
Practice Address - Country:US
Practice Address - Phone:787-757-1800
Practice Address - Fax:787-276-2205
Is Sole Proprietor?:No
Enumeration Date:2018-10-23
Last Update Date:2018-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program