1952532566 NPI number — WILSANIA L. RODRIGUEZ MENDEZ M.D.

Table of content: WILSANIA L. RODRIGUEZ MENDEZ M.D. (NPI 1952532566)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1952532566 NPI number — WILSANIA L. RODRIGUEZ MENDEZ M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RODRIGUEZ MENDEZ
Provider First Name:
WILSANIA
Provider Middle Name:
L.
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1952532566
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/30/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
POST OFFICE BOX 769
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BAYOU LA BATRE
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
36509-0769
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
251-824-2174
Provider Business Mailing Address Fax Number:
251-824-2286

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12701 PADGETT SWITCH ROAD
Provider Second Line Business Practice Location Address:
MEDICINE DEPT.
Provider Business Practice Location Address City Name:
IRVINGTON
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
36544-4011
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
251-824-2174
Provider Business Practice Location Address Fax Number:
251-824-2174
Provider Enumeration Date:
07/30/2009

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  31896 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 140600 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 511-28738 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 103589700 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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