Healthcare Provider Details

I. General information

NPI: 1275675738
Provider Name (Legal Business Name): MARIA A RODRIGUEZ MS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/13/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ITURREGUI PLAZA 217-A
SAN JUAN PR
00926
US

IV. Provider business mailing address

ITURREGUI PLAZA 217-A
SAN JUAN PR
00926
US

V. Phone/Fax

Practice location:
  • Phone: 787-768-5501
  • Fax: 787-768-8094
Mailing address:
  • Phone: 787-768-5501
  • Fax: 787-768-8094

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number1741
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: