Healthcare Provider Details

I. General information

NPI: 1396657011
Provider Name (Legal Business Name): NEREIDA IVETTE RODRIGUEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/18/2026
Last Update Date: 09/18/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

URB SANTA JUANITA G1 AVE LAUREL
BAYAMON PR
00956-4451
US

IV. Provider business mailing address

839 CALLE ANASCO APT 705
SAN JUAN PR
00925-2454
US

V. Phone/Fax

Practice location:
  • Phone: 787-269-4250
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number8725
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: