Healthcare Provider Details

I. General information

NPI: 1144702994
Provider Name (Legal Business Name): VIVIANA RODRIGUEZ SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/29/2018
Last Update Date: 08/29/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

URB BRISAS DE LAUREL CALLE DIAMANTE 441
COTO LAUREL PR
00780-2220
US

IV. Provider business mailing address

URB BRISAS DE LAUREL CALLE DIAMANTE 441
COTO LAUREL PR
00780
US

V. Phone/Fax

Practice location:
  • Phone: 787-449-3422
  • Fax:
Mailing address:
  • Phone: 787-449-3422
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number4087
License Number StatePR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: