Provider Demographics
NPI:1538240858
Name:RODRIGUEZ, TERESITA (MSA)
Entity type:Individual
Prefix:MRS
First Name:TERESITA
Middle Name:
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:MSA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 7225
Mailing Address - Street 2:
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00726-7225
Mailing Address - Country:US
Mailing Address - Phone:787-746-7557
Mailing Address - Fax:787-746-7557
Practice Address - Street 1:5 CALLE AGUAS BUENAS
Practice Address - Street 2:
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00727-4947
Practice Address - Country:US
Practice Address - Phone:787-746-7557
Practice Address - Fax:787-746-7557
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-17
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR00181237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0064017Medicare UPIN