Healthcare Provider Details

I. General information

NPI: 1538240858
Provider Name (Legal Business Name): TERESITA RODRIGUEZ MSA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/17/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 CALLE AGUAS BUENAS
CAGUAS PR
00727-4947
US

IV. Provider business mailing address

PO BOX 7225
CAGUAS PR
00726-7225
US

V. Phone/Fax

Practice location:
  • Phone: 787-746-7557
  • Fax: 787-746-7557
Mailing address:
  • Phone: 787-746-7557
  • Fax: 787-746-7557

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number00181
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: