Healthcare Provider Details

I. General information

NPI: 1992307599
Provider Name (Legal Business Name): JANICE RODRIGUEZ BREA NL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/10/2020
Last Update Date: 07/21/2022
Certification Date: 11/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 CARR 842 APT 2606
SAN JUAN PR
00926-9758
US

IV. Provider business mailing address

140 CARR 842 APT 2606
SAN JUAN PR
00926-9758
US

V. Phone/Fax

Practice location:
  • Phone: 939-414-7383
  • Fax:
Mailing address:
  • Phone: 939-414-7383
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: