=====================================================
General NPI Number Information
=====================================================
NPI Number | 1245317312
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MRS. CAROLYN RODRIGUEZ
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/01/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4406 AVE MILITAR BO. COTTO
-----------------------------------------------------
City | ISABELA
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00662-4158
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-872-5943
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 3350
-----------------------------------------------------
City | AGUADILLA
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00605-3350
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-872-5943
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183700000X
-----------------------------------------------------
Taxonomy Name | Pharmacy Technician
-----------------------------------------------------
License Number | 4801
-----------------------------------------------------
License Number State | PR
-----------------------------------------------------