Provider Demographics
NPI:1548492721
Name:RODRIGUEZ, MICHELLE (LND)
Entity type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:LND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:O10 CALLE 19
Mailing Address - Street 2:URB. EL CORTIJO
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00956-5617
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:O10 CALLE 19
Practice Address - Street 2:URB. EL CORTIJO
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00956-5617
Practice Address - Country:US
Practice Address - Phone:939-630-1166
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-20
Last Update Date:2009-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1421133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered