Healthcare Provider Details

I. General information

NPI: 1356738025
Provider Name (Legal Business Name): GETSENI RODRIGUEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/21/2015
Last Update Date: 04/21/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

V6 CALLE 15 ALTURAS DE INTERAMERICANA
TRUJILLO ALTO PR
00976
US

IV. Provider business mailing address

V6 CALLE 15 ALTURAS DE INTERAMERICANA
TRUJILLO ALTO PR
00976
US

V. Phone/Fax

Practice location:
  • Phone: 787-409-0115
  • Fax:
Mailing address:
  • Phone: 787-409-0115
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number1891
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: