Provider Demographics
NPI:1003455023
Name:TALAVERA RODRIGUEZ, GINALETTE (OD)
Entity Type:Individual
Prefix:DR
First Name:GINALETTE
Middle Name:
Last Name:TALAVERA RODRIGUEZ
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 CALLE COLON STE 16
Mailing Address - Street 2:
Mailing Address - City:AGUADA
Mailing Address - State:PR
Mailing Address - Zip Code:00602-3167
Mailing Address - Country:US
Mailing Address - Phone:787-589-7468
Mailing Address - Fax:787-589-7469
Practice Address - Street 1:2 CALLE COLON STE 16
Practice Address - Street 2:
Practice Address - City:AGUADA
Practice Address - State:PR
Practice Address - Zip Code:00602-3167
Practice Address - Country:US
Practice Address - Phone:787-589-7468
Practice Address - Fax:787-589-7469
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-23
Last Update Date:2019-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR746-447152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist