Provider Demographics
NPI:1699091009
Name:RODRIGUEZ RODRIGUEZ, ILIANA M (TO)
Entity type:Individual
Prefix:MRS
First Name:ILIANA
Middle Name:M
Last Name:RODRIGUEZ RODRIGUEZ
Suffix:
Gender:F
Credentials:TO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:URB. MIRADERO #118 CAMINO DE LAS VISTAS
Mailing Address - Street 2:
Mailing Address - City:HUMACAO
Mailing Address - State:PR
Mailing Address - Zip Code:00791-9735
Mailing Address - Country:US
Mailing Address - Phone:787-299-3906
Mailing Address - Fax:
Practice Address - Street 1:BO. MARIANA I CARR. 3 URB. MIRADERO
Practice Address - Street 2:CAMINO DE LAS VISTAS 118
Practice Address - City:HUMACAO
Practice Address - State:PR
Practice Address - Zip Code:00791-9735
Practice Address - Country:US
Practice Address - Phone:787-299-3906
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-09
Last Update Date:2011-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1012225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist