Healthcare Provider Details

I. General information

NPI: 1609086370
Provider Name (Legal Business Name): MARISOL RODRIGUEZ OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2007
Last Update Date: 10/05/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12 CALLE ROBLES
RIO PIEDRAS PR
00925-2919
US

IV. Provider business mailing address

12 CALLE ROBLES LA CUMBRE
SAN JUAN PR
00925-2919
US

V. Phone/Fax

Practice location:
  • Phone: 787-766-9376
  • Fax:
Mailing address:
  • Phone: 787-766-9376
  • Fax: 787-766-9376

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number397
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: