Provider Demographics
NPI:1093998734
Name:RODRIGUEZ, LILLIAM ISABEL (LND)
Entity Type:Individual
Prefix:MS
First Name:LILLIAM
Middle Name:ISABEL
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:LND
Other - Prefix:MS
Other - First Name:LILLIAM
Other - Middle Name:ISABEL
Other - Last Name:RODRIGUEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LND
Mailing Address - Street 1:Q12 CALLE HUCAR
Mailing Address - Street 2:VALLE ARRIBA HEIGHTS
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00983-3449
Mailing Address - Country:US
Mailing Address - Phone:787-367-1734
Mailing Address - Fax:
Practice Address - Street 1:1715 AVE PONCE DE LEON
Practice Address - Street 2:NUTRITION DEPT
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00909-1958
Practice Address - Country:US
Practice Address - Phone:787-758-2000
Practice Address - Fax:787-771-7951
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-17
Last Update Date:2007-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR991133NN1002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR991OtherLND