Provider Demographics
NPI:1215202080
Name:RODRIGUEZ, GRELAINE (PHL)
Entity Type:Individual
Prefix:MRS
First Name:GRELAINE
Middle Name:
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:PHL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC-1 BOX 1635
Mailing Address - Street 2:
Mailing Address - City:BOQUERON
Mailing Address - State:PUERTO RICO
Mailing Address - Zip Code:00622
Mailing Address - Country:UM
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:HC 1 BOX 1635
Practice Address - Street 2:
Practice Address - City:BOQUERON
Practice Address - State:PR
Practice Address - Zip Code:00622-9619
Practice Address - Country:US
Practice Address - Phone:787-380-7330
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-13
Last Update Date:2014-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2062235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist