Provider Demographics
NPI:1861627762
Name:RODRIGUEZ, MIREILYS (LND)
Entity type:Individual
Prefix:MISS
First Name:MIREILYS
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:HC 75 BOX 1475 BO ANONES
Mailing Address - Street 2:
Mailing Address - City:NARANJITO
Mailing Address - State:PR
Mailing Address - Zip Code:00719-9727
Mailing Address - Country:US
Mailing Address - Phone:787-459-8719
Mailing Address - Fax:
Practice Address - Street 1:HC 75 BOX 1475 BO ANONES
Practice Address - Street 2:
Practice Address - City:NARANJITO
Practice Address - State:PR
Practice Address - Zip Code:00719-9727
Practice Address - Country:US
Practice Address - Phone:787-459-8719
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-20
Last Update Date:2009-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1493133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist