Provider Demographics
NPI:1194408120
Name:RODRIGUEZ BONET, MADELINE (MRC, LRC, CRC)
Entity type:Individual
Prefix:MRS
First Name:MADELINE
Middle Name:
Last Name:RODRIGUEZ BONET
Suffix:
Gender:F
Credentials:MRC, LRC, CRC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11044 CALLE AMERICA
Mailing Address - Street 2:
Mailing Address - City:COTO LAUREL
Mailing Address - State:PR
Mailing Address - Zip Code:00780-2044
Mailing Address - Country:US
Mailing Address - Phone:787-284-5884
Mailing Address - Fax:
Practice Address - Street 1:8169 CALLE CONCORDIA
Practice Address - Street 2:
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00717-1554
Practice Address - Country:US
Practice Address - Phone:787-284-5884
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-08
Last Update Date:2023-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4919814171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator