Healthcare Provider Details

I. General information

NPI: 1982535142
Provider Name (Legal Business Name): MYREISHKA MARIE RODRIGUEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2026
Last Update Date: 05/27/2026
Certification Date: 05/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PR-2 KM. 124.2 BO. CORRALES
AGUADILLA PR
00603
US

IV. Provider business mailing address

210 CALLE SANTA ROSA
AGUADILLA PR
00603-5729
US

V. Phone/Fax

Practice location:
  • Phone: 787-461-7285
  • Fax:
Mailing address:
  • Phone: 787-461-7285
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number1344
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: