Provider Demographics
NPI:1699292128
Name:RODRIGUEZ ROSA, SYLVIA J
Entity type:Individual
Prefix:
First Name:SYLVIA
Middle Name:J
Last Name:RODRIGUEZ ROSA
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:HC 6 BOX 11517
Mailing Address - Street 2:
Mailing Address - City:YABUCOA
Mailing Address - State:PR
Mailing Address - Zip Code:00767-9791
Mailing Address - Country:US
Mailing Address - Phone:787-850-2040
Mailing Address - Fax:
Practice Address - Street 1:344 AVE FONT MARTELO
Practice Address - Street 2:
Practice Address - City:HUMACAO
Practice Address - State:PR
Practice Address - Zip Code:00791-3228
Practice Address - Country:US
Practice Address - Phone:787-850-2040
Practice Address - Fax:787-850-2040
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-25
Last Update Date:2017-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR10970183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician