Healthcare Provider Details

I. General information

NPI: 1699081901
Provider Name (Legal Business Name): CELIMAR RODRIGUEZ MA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/24/2010
Last Update Date: 08/24/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

RD. 3 KM 27.0
RIO GRANDE PR
00745
US

IV. Provider business mailing address

PO BOX 26
FAJARDO PR
00738-0026
US

V. Phone/Fax

Practice location:
  • Phone: 787-513-2828
  • Fax:
Mailing address:
  • Phone: 787-598-3209
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number917
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: