Basic Information
| Provider Information | |||||||||
| NPI: | 1598304883 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RODRIGUEZ | ||||||||
| FirstName: | CARMEN | ||||||||
| MiddleName: | ENILDA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 237-21 CALLE 615 | ||||||||
| Address2: | |||||||||
| City: | CAROLINA | ||||||||
| State: | PR | ||||||||
| PostalCode: | 009852231 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7877529644 | ||||||||
| FaxNumber: | 7872570770 | ||||||||
| Practice Location | |||||||||
| Address1: | 237-21 CALLE 615 | ||||||||
| Address2: | |||||||||
| City: | CAROLINA | ||||||||
| State: | PR | ||||||||
| PostalCode: | 009852231 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7877529644 | ||||||||
| FaxNumber: | 7872570770 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/03/2020 | ||||||||
| LastUpdateDate: | 01/03/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 01/03/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 183500000X | 2056 | PR | Y | 193400000X SINGLE SPECIALTY GROUP | Pharmacy Service Providers | Pharmacist |
No ID Information.