Provider Demographics
NPI:1679557771
Name:RODRIGUEZ ORTIZ, ARLEEN M (MD)
Entity type:Individual
Prefix:
First Name:ARLEEN
Middle Name:M
Last Name:RODRIGUEZ ORTIZ
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 1:34 PARQ LA ARBOLEDA
Mailing Address - Street 2:
Mailing Address - City:AGUADILLA
Mailing Address - State:PR
Mailing Address - Zip Code:00603-6743
Mailing Address - Country:US
Mailing Address - Phone:787-604-6578
Mailing Address - Fax:787-868-6108
Practice Address - Street 1:137 CALLE COLON
Practice Address - Street 2:
Practice Address - City:AGUADA
Practice Address - State:PR
Practice Address - Zip Code:00602-3001
Practice Address - Country:US
Practice Address - Phone:787-868-6108
Practice Address - Fax:787-868-6108
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-01
Last Update Date:2015-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR12533207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR90012OtherTRIPLE S
PREM708AOtherMEDICARE PTAN
PR90012OtherTRIPLE S