Healthcare Provider Details

I. General information

NPI: 1609357920
Provider Name (Legal Business Name): MONICA LIZ RODRIGUEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/24/2018
Last Update Date: 08/24/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

TORRE MEDICA 2 DR PEDRO BLANCO LUGO 200 CARR 2 SUITE 2-51
MANATI PR
00674
US

IV. Provider business mailing address

TORRE MEDICA 2 DR PEDRO BLANCO LUGO 200 CARR 2 SUITE 2-51
MANATI PR
00674
US

V. Phone/Fax

Practice location:
  • Phone: 787-507-3644
  • Fax: 787-680-0844
Mailing address:
  • Phone: 787-507-3644
  • Fax: 787-680-0844

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
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: