1093998734 NPI number — MS. LILLIAM ISABEL RODRIGUEZ LND

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093998734 NPI number — MS. LILLIAM ISABEL RODRIGUEZ LND

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RODRIGUEZ
Provider First Name:
LILLIAM
Provider Middle Name:
ISABEL
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
LND
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
RODRIGUEZ
Provider Other First Name:
LILLIAM
Provider Other Middle Name:
ISABEL
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
LND
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1093998734
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/17/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
Q12 CALLE HUCAR
Provider Second Line Business Mailing Address:
VALLE ARRIBA HEIGHTS
Provider Business Mailing Address City Name:
CAROLINA
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00983-3449
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-367-1734
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1715 AVE PONCE DE LEON
Provider Second Line Business Practice Location Address:
NUTRITION DEPT
Provider Business Practice Location Address City Name:
SAN JUAN
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00909-1958
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-758-2000
Provider Business Practice Location Address Fax Number:
787-771-7951
Provider Enumeration Date:
12/17/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 133NN1002X , with the licence number:  991 , registered in the state of PR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 991 . This is a "LND" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".




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