Provider Demographics
NPI:1134496029
Name:RODRIGUEZ, LILLIAM (LND)
Entity Type:Individual
Prefix:MRS
First Name:LILLIAM
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:COND VEREDAS DEL MAR
Mailing Address - Street 2:APAT 3-102
Mailing Address - City:VEGA BAJA
Mailing Address - State:PR
Mailing Address - Zip Code:00693
Mailing Address - Country:US
Mailing Address - Phone:787-688-0055
Mailing Address - Fax:
Practice Address - Street 1:CARRETERA 693
Practice Address - Street 2:266 BARRIO BRENA
Practice Address - City:VEGA ALTA
Practice Address - State:PUERTO RICO
Practice Address - Zip Code:00692
Practice Address - Country:UM
Practice Address - Phone:787-531-9227
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-21
Last Update Date:2011-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1367133NN1002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education