1659586394 NPI number — EDITH MARIE RODRIGUEZ PHARMD

Table of content: EDITH MARIE RODRIGUEZ PHARMD (NPI 1659586394)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659586394 NPI number — EDITH MARIE RODRIGUEZ PHARMD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RODRIGUEZ
Provider First Name:
EDITH
Provider Middle Name:
MARIE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PHARMD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1659586394
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
A19 URB EL MAESTRO
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CAMUY
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00627-2708
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-817-9752
Provider Business Mailing Address Fax Number:
787-879-4211

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
129 KM 3.7 MARGINAL
Provider Second Line Business Practice Location Address:
BO HATO ARRIBA
Provider Business Practice Location Address City Name:
ARECIBO
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00612
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-879-4210
Provider Business Practice Location Address Fax Number:
787-879-4211
Provider Enumeration Date:
05/14/2007

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: 183500000X , with the licence number:  4620 , 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)