Healthcare Provider Details

I. General information

NPI: 1932356987
Provider Name (Legal Business Name): JEANNETTE TOLEDO RODRIGUEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/21/2008
Last Update Date: 02/03/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

HC 6 BOX 10560
HATILLO PR
00659-6638
US

IV. Provider business mailing address

HC-6 BOX10560
HATILLO PR
00659
US

V. Phone/Fax

Practice location:
  • Phone: 787-820-3183
  • Fax: 787-820-3183
Mailing address:
  • Phone: 787-820-3183
  • Fax: 787-820-3183

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code246RM2200X
TaxonomyMedical Laboratory Technician
License Number3304
License Number StatePR
# 2
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number764
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: