MEDICARE: MRS. THAIRA ENID RODRIGUEZ NL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	175F00000X	Naturopath

General Provider Information

NPI Number	:	1487256848
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. THAIRA ENID RODRIGUEZ NL

Provider Business Mailing Address
First Line	:	62 CALLE AMISTAD
Second Line	:	URB LAS CAMPINAS II
City	:	LAS PIEDRAS
State	:	PR
Zip	:	00771-7306
Country	:	US
Telephone Number	:	787-503-0104
Fax Number	:

Provider Business Practice Location Address
First Line	:	62 CALLE AMISTAD
Second Line	:	URB LAS CAMPINAS II
City	:	LAS PIEDRAS
State	:	PR
Zip	:	00771-7306
Country	:	US
Telephone Number	:	787-503-0104
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/11/2020
Last Update Date	:	11/11/2020

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