Provider Demographics
NPI:1124031471
Name:RODRIGUEZ, MAYRA (CLINICAL NURSE SPEC)
Entity Type:Individual
Prefix:
First Name:MAYRA
Middle Name:
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:CLINICAL NURSE SPEC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:# D-3, NO. 1 ST.
Mailing Address - Street 2:HILL SIDE
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926
Mailing Address - Country:US
Mailing Address - Phone:787-317-3949
Mailing Address - Fax:
Practice Address - Street 1:#10 CASIA ST. SAN JUAN
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00921
Practice Address - Country:US
Practice Address - Phone:787-641-7582
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR23132364SM0705X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SM0705XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistMedical-Surgical