Provider Demographics
NPI:1144898065
Name:ROSARIO RODRIGUEZ, ILEANA
Entity type:Individual
Prefix:
First Name:ILEANA
Middle Name:
Last Name:ROSARIO 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:HC 2 BOX 6388
Mailing Address - Street 2:
Mailing Address - City:MOROVIS
Mailing Address - State:PR
Mailing Address - Zip Code:00687-8830
Mailing Address - Country:US
Mailing Address - Phone:787-236-3905
Mailing Address - Fax:
Practice Address - Street 1:CARR. 21 NUM. 1785
Practice Address - Street 2:AVE. LAS LOMAS #21
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00687
Practice Address - Country:US
Practice Address - Phone:787-782-9999
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-16
Last Update Date:2021-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11004439367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty