Provider Demographics
NPI:1205690575
Name:RODRIGUEZ, MARIA L (LIC)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:L
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:LIC
Other - Prefix:
Other - First Name:MARIA
Other - Middle Name:L
Other - Last Name:RODRIGUEZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LIC
Mailing Address - Street 1:PO BOX 800192
Mailing Address - Street 2:
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00780-0192
Mailing Address - Country:US
Mailing Address - Phone:787-383-5571
Mailing Address - Fax:
Practice Address - Street 1:2972 AVE EMILIO FAGOT
Practice Address - Street 2:
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00716-3615
Practice Address - Country:US
Practice Address - Phone:787-651-7691
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-07
Last Update Date:2024-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR0050212355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant