Healthcare Provider Details

I. General information

NPI: 1376640722
Provider Name (Legal Business Name): MILAGROS E RODRIGUEZ COUTO MT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

LAJAS ROAD 25 B
ENSENADA PR
00647
US

IV. Provider business mailing address

PO BOX 96
ENSENADA PR
00647-0096
US

V. Phone/Fax

Practice location:
  • Phone: 787-821-3008
  • Fax: 787-821-3008
Mailing address:
  • Phone: 787-821-3008
  • Fax: 787-821-3008

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246RM2200X
TaxonomyMedical Laboratory Technician
License Number583
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: