Provider Demographics
NPI:1215162201
Name:RODRIGUEZ, ANAIDA M
Entity type:Individual
Prefix:
First Name:ANAIDA
Middle Name:M
Last Name:RODRIGUEZ
Suffix:
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:PO BOX 2055
Mailing Address - Street 2:
Mailing Address - City:SALINAS
Mailing Address - State:PR
Mailing Address - Zip Code:00751-2001
Mailing Address - Country:US
Mailing Address - Phone:787-845-0458
Mailing Address - Fax:787-845-0458
Practice Address - Street 1:AVE. LUIS MUNOZ RIVERA 91
Practice Address - Street 2:
Practice Address - City:SANTA ISABEL
Practice Address - State:PR
Practice Address - Zip Code:00757-0057
Practice Address - Country:US
Practice Address - Phone:787-845-1188
Practice Address - Fax:787-845-1188
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-20
Last Update Date:2009-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR166451041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical