Healthcare Provider Details

I. General information

NPI: 1093670218
Provider Name (Legal Business Name): NARDA PETRIE RODRIGUEZ ROSA MS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/19/2025
Last Update Date: 12/19/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 579
HUMACAO PR
00792-0579
US

IV. Provider business mailing address

URB RIVER EDGE HILLS 83 CL RIO CANOVANILLAS
LUQUILLO PR
00773
US

V. Phone/Fax

Practice location:
  • Phone: 787-285-3978
  • Fax:
Mailing address:
  • Phone: 787-615-2956
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number676
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: