Healthcare Provider Details

I. General information

NPI: 1407068190
Provider Name (Legal Business Name): YARALIZ RODRIGUEZ-MARTINEZ R.PH.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/04/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

BARRIO MONACILLOS, CENTRO MEDICO DE PR HOSPITAL SAN JUAN
SAN JUAN PR
00926
US

IV. Provider business mailing address

402 CALLE GRAN AUSUBO CIUDAD JARDIN III
TOA ALTA PR
00953-4887
US

V. Phone/Fax

Practice location:
  • Phone: 787-766-2223
  • Fax: 787-250-8449
Mailing address:
  • Phone: 787-799-7472
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number4963
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: