Healthcare Provider Details

I. General information

NPI: 1699900357
Provider Name (Legal Business Name): IVETTE RODRIGUEZ MSN, WCNS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/26/2009
Last Update Date: 05/26/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CALLE J.R GARZOT #33 LOCAL #2
NAGUABO PR
00718
US

IV. Provider business mailing address

CALLE 7 F-32 TURABO GARDENS
CAGUAS PR
00725
US

V. Phone/Fax

Practice location:
  • Phone: 787-649-4967
  • Fax:
Mailing address:
  • Phone: 787-223-6989
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WW0000X
TaxonomyWound Care Registered Nurse
License Number187
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: