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General NPI Number Information
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NPI Number | 1356737316
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Entity Type | Individual
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Provider Name | ELAINE MARIE RODRIGUEZ M.S.
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Gender | Female
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Dates
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Enumeration Date | 04/07/2015
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Last Update Date | 06/09/2021
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Provider Practice Location Address
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Address Line | #3640 AVE. BOULEVARD
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City | TOA BAJA
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State | PR
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Zip | 00949
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Country | US
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Telephone | 787-961-8077
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Fax |
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Provider Business Mailing Address
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Address Line | URB. LOS FAROLES #89 CALLE PASEO LA GALETA
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City | BAYAMON
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State | PR
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Zip | 00956
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Country | US
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Telephone | 787-506-5711
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 4092
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License Number State | PR
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Taxonomy #2
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Taxonomy Code | 2355S0801X
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Taxonomy Name | Speech-Language Assistant
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License Number | 005017
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License Number State | PR
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