Healthcare Provider Details

I. General information

NPI: 1962433847
Provider Name (Legal Business Name): YAHAIRA RODRIGUEZ MC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

AVE. GAUTIER BENITEZ ANEXO B-5 CONSOLIDATED MALL
CAGUAS PR
00725
US

IV. Provider business mailing address

825 URB. VIRGINIA VALLEY
JUNCOS PR
00777
US

V. Phone/Fax

Practice location:
  • Phone: 787-704-0705
  • Fax: 787-704-0780
Mailing address:
  • Phone: 787-691-5533
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: