MEDICARE: GLORIVETTE RODRIGUEZ NL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	175F00000X	Naturopath	205	PR

General Provider Information

NPI Number	:	1760081145
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GLORIVETTE RODRIGUEZ NL

Provider Business Mailing Address
First Line	:	D13 LAS VILLAS TOWNHOUSES
Second Line	:
City	:	GUAYNABO
State	:	PR
Zip	:	00969-3267
Country	:	US
Telephone Number	:	787-614-6345
Fax Number	:

Provider Business Practice Location Address
First Line	:	D13 LAS VILLAS TOWNHOUSES
Second Line	:
City	:	GUAYNABO
State	:	PR
Zip	:	00969-3267
Country	:	US
Telephone Number	:	787-614-6345
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/18/2020
Last Update Date	:	10/18/2020

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