Healthcare Provider Details

I. General information

NPI: 1386589620
Provider Name (Legal Business Name): JEIZEL MARI RODRIGUEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/22/2026
Last Update Date: 04/22/2026
Certification Date: 04/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40790 CARR 478
QUEBRADILLAS PR
00678-9305
US

IV. Provider business mailing address

40790 CARR 478
QUEBRADILLAS PR
00678-9305
US

V. Phone/Fax

Practice location:
  • Phone: 787-243-3060
  • Fax:
Mailing address:
  • Phone: 787-243-3060
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License Number6663-1
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: