Provider Demographics
NPI:1316152937
Name:RODRIGUEZ, DORIS MYRIAM
Entity type:Individual
Prefix:
First Name:DORIS
Middle Name:MYRIAM
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 1:3044 AVE JUAN HERNANDEZ ORTIZ
Mailing Address - Street 2:
Mailing Address - City:ISABELA
Mailing Address - State:PR
Mailing Address - Zip Code:00662-3603
Mailing Address - Country:US
Mailing Address - Phone:787-872-8401
Mailing Address - Fax:
Practice Address - Street 1:3044 AVE JUAN HERNANDEZ ORTIZ
Practice Address - Street 2:
Practice Address - City:ISABELA
Practice Address - State:PR
Practice Address - Zip Code:00662-3603
Practice Address - Country:US
Practice Address - Phone:787-872-5110
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4972183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician