Provider Demographics
NPI:1316424500
Name:RODRIGUEZ ROMAN, WANDA MILAGROS (MSW)
Entity type:Individual
Prefix:
First Name:WANDA
Middle Name:MILAGROS
Last Name:RODRIGUEZ ROMAN
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:208 CALLE VALENCIA
Mailing Address - Street 2:URB NUEVA SALAMANCA
Mailing Address - City:SAN GERMAN
Mailing Address - State:PR
Mailing Address - Zip Code:00683
Mailing Address - Country:US
Mailing Address - Phone:787-445-8586
Mailing Address - Fax:
Practice Address - Street 1:208 CALLE VALENCIA
Practice Address - Street 2:URB NUEVA SALAMANCA
Practice Address - City:SAN GERMAN
Practice Address - State:PR
Practice Address - Zip Code:00683-0068
Practice Address - Country:US
Practice Address - Phone:787-445-8586
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-20
Last Update Date:2018-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR129231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty