Healthcare Provider Details

I. General information

NPI: 1629685565
Provider Name (Legal Business Name): MARLENE BRIDGETTE RODRIGUEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/24/2020
Last Update Date: 07/15/2026
Certification Date: 07/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

SALIDA 21 CARR. 172 URB. TURABO GARDENS
CAGUAS PR
00726
US

IV. Provider business mailing address

SALIDA 21 CARR. 172 URB. TURABO GARDENS
CAGUAS PR
00726
US

V. Phone/Fax

Practice location:
  • Phone: 787-743-3038
  • Fax:
Mailing address:
  • Phone: 787-743-3038
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number025056
License Number StatePR
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: