Provider Demographics
NPI:1154996304
Name:RODRIGUEZ, ITZEL I
Entity type:Individual
Prefix:
First Name:ITZEL
Middle Name:I
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ITZEL
Other - Middle Name:I
Other - Last Name:RODRIGUEZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS SLP
Mailing Address - Street 1:J6 AVE SAN PATRICIO APT 10C
Mailing Address - Street 2:
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00968-4423
Mailing Address - Country:US
Mailing Address - Phone:787-951-1045
Mailing Address - Fax:
Practice Address - Street 1:J6 AVE SAN PATRICIO APT 10C
Practice Address - Street 2:
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00968-4423
Practice Address - Country:US
Practice Address - Phone:787-951-1045
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-20
Last Update Date:2021-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4289235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist