Provider Demographics
NPI:1063070456
Name:RODRIGUEZ, MARICELY RODRIGUEZ SR
Entity type:Individual
Prefix:
First Name:MARICELY
Middle Name:RODRIGUEZ
Last Name:RODRIGUEZ
Suffix:SR
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:URBANIZACION COUNTRY CLUB
Mailing Address - Street 2:1165 OLIVIA PAOLI
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00924
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:MMM PLAZA BECHARA INDUSTRIAL PARK
Practice Address - Street 2:411 AVE MARGINAL KENNEDY
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00936
Practice Address - Country:US
Practice Address - Phone:787-622-3000
Practice Address - Fax:787-999-1767
Is Sole Proprietor?:No
Enumeration Date:2019-05-31
Last Update Date:2019-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR34730163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice