Provider Demographics
NPI:1871544221
Name:RODRIGUEZ VELLON, YAZMIN (MD)
Entity type:Individual
Prefix:
First Name:YAZMIN
Middle Name:
Last Name:RODRIGUEZ VELLON
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 236
Mailing Address - Street 2:
Mailing Address - City:VEGA BAJA
Mailing Address - State:PR
Mailing Address - Zip Code:00694-0236
Mailing Address - Country:US
Mailing Address - Phone:939-969-2177
Mailing Address - Fax:
Practice Address - Street 1:LAS BRISAS CARR 129 KM 5.9
Practice Address - Street 2:
Practice Address - City:ARECIBO
Practice Address - State:PR
Practice Address - Zip Code:00612-0612
Practice Address - Country:US
Practice Address - Phone:787-880-6711
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR11199207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR84547Medicare ID - Type Unspecified