Healthcare Provider Details

I. General information

NPI: 1982969382
Provider Name (Legal Business Name): GLADYS A. RODRIGUEZ MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/11/2012
Last Update Date: 06/13/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

49 CALLE MORELL CAMPOS
ARECIBO PR
00612-4318
US

IV. Provider business mailing address

PO BOX 3359
ARECIBO PR
00613-3359
US

V. Phone/Fax

Practice location:
  • Phone: 787-236-9082
  • Fax: 787-878-0683
Mailing address:
  • Phone: 787-236-9082
  • Fax: 787-878-0683

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number10447.
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: