Provider Demographics
NPI:1962888594
Name:RODRIGUEZ, ZORAIDA
Entity type:Individual
Prefix:
First Name:ZORAIDA
Middle Name:
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 1:208 CALLE C
Mailing Address - Street 2:BUENA VISTA
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00917-0208
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:208 CALLE C
Practice Address - Street 2:BUENA VISTA
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00917-0208
Practice Address - Country:US
Practice Address - Phone:787-447-5486
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-05
Last Update Date:2015-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR409156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician