MEDICARE: MS. VIVIAN MARIE RODRIGUEZ MS, PHL

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	235Z00000X	Speech-Language Pathologist	4660	PR

General Provider Information

NPI Number	:	1942142138
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. VIVIAN MARIE RODRIGUEZ MS, PHL

Provider Business Mailing Address
First Line	:	G9 AVE SAN PATRICIO
Second Line	:
City	:	GUAYNABO
State	:	PR
Zip	:	00968-3214
Country	:	US
Telephone Number	:	787-399-3105
Fax Number	:

Provider Business Practice Location Address
First Line	:	G9 AVE SAN PATRICIO
Second Line	:
City	:	GUAYNABO
State	:	PR
Zip	:	00968-3214
Country	:	US
Telephone Number	:	787-399-3105
Fax Number	:

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

Provider Enumeration Date	:	04/07/2026
Last Update Date	:	04/07/2026

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