Healthcare Provider Details

I. General information

NPI: 1407079445
Provider Name (Legal Business Name): MRS. LILLIAN RODRIGUEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

BOULEVARD ALFONSO VALDES #259
MAYAGUEZ PR
00680
US

IV. Provider business mailing address

URB. MONTERIO 732 CALLE TURABO
MAYAGUEZ PR
00680
US

V. Phone/Fax

Practice location:
  • Phone: 787-832-4040
  • Fax:
Mailing address:
  • Phone: 787-832-4040
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247ZC0005X
TaxonomyClinical Laboratory Director (Non-physician)
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: