=====================================================
General NPI Number Information
=====================================================
NPI Number | 1578875399
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | BRENDA E RODRIGUEZ OPTICIAN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/09/2010
-----------------------------------------------------
Last Update Date | 07/09/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | ALBACETTE 518 URB VALENCIA
-----------------------------------------------------
City | SAN JUAN
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00923
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-529-8857
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 518 CALLE ALBACETE
-----------------------------------------------------
City | SAN JUAN
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00923-1620
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-529-8857
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 156FX1800X
-----------------------------------------------------
Taxonomy Name | Optician
-----------------------------------------------------
License Number | 401
-----------------------------------------------------
License Number State | PR
-----------------------------------------------------