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General NPI Number Information
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NPI Number | 1578876850
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Entity Type | Individual
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Provider Name | NYDIA M. RODRIGUEZ 761
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Gender | Female
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Dates
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Enumeration Date | 07/15/2010
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Last Update Date | 07/15/2010
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Provider Practice Location Address
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Address Line | AVE.BARALT CALLE PRINCIPAL I-8
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City | FAJARDO
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State | PR
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Zip | 00738-0008
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Country | US
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Telephone | 787-514-7696
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 255
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City | LUQUILLO
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State | PR
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Zip | 00773-0255
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Country | US
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Telephone | 787-514-7696
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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 | 156FX1800X
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Taxonomy Name | Optician
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License Number | 761
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License Number State | PR
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