Healthcare Provider Details

I. General information

NPI: 1124031471
Provider Name (Legal Business Name): MAYRA RODRIGUEZ CLINICAL NURSE SPEC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/15/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

#10 CASIA ST. SAN JUAN
SAN JUAN PR
00921
US

IV. Provider business mailing address

# D-3, NO. 1 ST. HILL SIDE
SAN JUAN PR
00926
US

V. Phone/Fax

Practice location:
  • Phone: 787-641-7582
  • Fax:
Mailing address:
  • Phone: 787-317-3949
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SM0705X
TaxonomyMedical-Surgical Clinical Nurse Specialist
License Number23132
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: