Healthcare Provider Details

I. General information

NPI: 1750513891
Provider Name (Legal Business Name): SHEILA RODRIGUEZ LND
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/21/2009
Last Update Date: 08/21/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1728 CALLE SEGRE RIO PIEDRAS HEIGHTS
SAN JUAN PR
00926-3257
US

IV. Provider business mailing address

T5 CALLE REINA DE LAS FLORES URB. SANTA CLARA
GUAYNABO PR
00969-6817
US

V. Phone/Fax

Practice location:
  • Phone: 787-384-5947
  • Fax:
Mailing address:
  • Phone: 787-384-5947
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number1529
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: