Basic Information
| Provider Information | |||||||||
| NPI: | 1790315497 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RODRIGUEZ | ||||||||
| FirstName: | CRISTINA | ||||||||
| MiddleName: | MARIA | ||||||||
| NamePrefix: | |||||||||
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| Credential: | LND | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 302 | ||||||||
| Address2: | |||||||||
| City: | CAMUY | ||||||||
| State: | PR | ||||||||
| PostalCode: | 006270302 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7873569983 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | CARRETERA 129 KM 1.0 AVENIDA SAN LUIS | ||||||||
| Address2: | HOSPITAL CAYETANO COLL Y TOSTE | ||||||||
| City: | ARECIBO | ||||||||
| State: | PR | ||||||||
| PostalCode: | 00612 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7876507272 | ||||||||
| FaxNumber: | 7876507248 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/22/2020 | ||||||||
| LastUpdateDate: | 01/22/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 01/22/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 133N00000X | 2123 | PR | Y | Dietary & Nutritional Service Providers | Nutritionist |
No ID Information.