Provider Demographics
NPI:1285933218
Name:RODRIGUEZ, MARIA A (OD)
Entity type:Individual
Prefix:DR
First Name:MARIA
Middle Name:A
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:OD
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 1615
Mailing Address - Street 2:
Mailing Address - City:LAJAS
Mailing Address - State:PR
Mailing Address - Zip Code:00667-1615
Mailing Address - Country:US
Mailing Address - Phone:787-519-7313
Mailing Address - Fax:787-274-0747
Practice Address - Street 1:525 AVE FD ROOSEVELT
Practice Address - Street 2:STE 140
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00918-8020
Practice Address - Country:US
Practice Address - Phone:787-777-0990
Practice Address - Fax:787-274-0747
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-16
Last Update Date:2016-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR334152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist