Healthcare Provider Details

I. General information

NPI: 1275720120
Provider Name (Legal Business Name): DELMA RODRIGUEZ BS MT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/25/2007
Last Update Date: 03/28/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3302 PASEO DE LA REINA MIGUEL POU
PONCE PR
00716-2441
US

IV. Provider business mailing address

3302 PASEO DE LA REINA MIGUEL POU
PONCE PR
00716-2441
US

V. Phone/Fax

Practice location:
  • Phone: 787-445-8267
  • Fax: 787-824-1003
Mailing address:
  • Phone: 787-445-8267
  • Fax: 787-824-1003

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246RM2200X
TaxonomyMedical Laboratory Technician
License Number3121
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: