Provider Demographics
NPI:1780978213
Name:RODRIGUEZ IGLESIAS, REALBA (MD)
Entity type:Individual
Prefix:DR
First Name:REALBA
Middle Name:
Last Name:RODRIGUEZ IGLESIAS
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 1:2494 WILLIAMSBRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10469-4806
Mailing Address - Country:US
Mailing Address - Phone:718-652-1802
Mailing Address - Fax:718-652-1889
Practice Address - Street 1:2494 WILLIAMSBRIDGE RD
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10469-4806
Practice Address - Country:US
Practice Address - Phone:718-652-1802
Practice Address - Fax:718-652-1889
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-01
Last Update Date:2013-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY263494207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03427754Medicaid