Provider Demographics
NPI:1417832726
Name:RODRIGUEZ MATEO, MAYRA IVELISSE (MD)
Entity type:Individual
Prefix:DR
First Name:MAYRA
Middle Name:IVELISSE
Last Name:RODRIGUEZ MATEO
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 424
Mailing Address - Street 2:
Mailing Address - City:AGUIRRE
Mailing Address - State:PR
Mailing Address - Zip Code:00704-0424
Mailing Address - Country:US
Mailing Address - Phone:787-223-3850
Mailing Address - Fax:
Practice Address - Street 1:8 CALLE COLON PACHECO
Practice Address - Street 2:
Practice Address - City:SALINAS
Practice Address - State:PR
Practice Address - Zip Code:00751-3344
Practice Address - Country:US
Practice Address - Phone:787-223-3850
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-06
Last Update Date:2025-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR572-P.A.363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical