Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 213E00000X | Podiatrist | SC004807 | PA |
N | 222Z00000X | Podiatrist | SC004807 | PA |
N | 213EP1101X | Primary Podiatric Medicine | SC-004807 | PA |
N | 111NR0200X | Radiology | SC-004807 | PA |
N | 213ER0200X | Radiology | SC-004807 | PA |
Y | 213ES0103X | Foot & Ankle Surgery | SC-004807 | PA |
N | 213ES0131X | Foot Surgery | SC-004807 | PA |
NPI | 1710972716 |
---|---|
Provider Name | Dr. Marinilda Rodriguez |
First Address | Allentown, PA 18109-0567 |
Second Address | Allentown, PA 18104-6704 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/09/2005 |
Last Update Date | 15/04/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0123110 | GHI (01) | |
101450010 0001 | MEDICAID (01) | |
1014500100001 | (05) | PA |
1761920 | HIGMARK BHLUE SHIELD (01) | |
50056100 | CAPITAL BLUE CROSS (01) | |
5669603 | CIGNA (01) | |
INDEPENDENCE BLUE CR | 1763939 (01) | |
V06388 | (02) |