Provider Demographics
NPI:1962774331
Name:RODRIGUEZ RAMOS, MELBA
Entity type:Individual
Prefix:
First Name:MELBA
Middle Name:
Last Name:RODRIGUEZ RAMOS
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 1:400 AVE FD ROOSEVELT STE 206
Mailing Address - Street 2:AVE. ROOSEVELT # 400
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00918-2129
Mailing Address - Country:US
Mailing Address - Phone:787-764-8787
Mailing Address - Fax:787-250-1029
Practice Address - Street 1:400 AVE FD ROOSEVELT STE 206
Practice Address - Street 2:AVE. ROOSEVELT # 400
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00918-2129
Practice Address - Country:US
Practice Address - Phone:787-764-8787
Practice Address - Fax:787-250-1029
Is Sole Proprietor?:No
Enumeration Date:2012-02-01
Last Update Date:2012-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR894133N00000X, 133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133N00000XDietary & Nutritional Service ProvidersNutritionist