Provider Demographics
NPI:1235376765
Name:RODRIGUEZ, LILLIAN (LND, MED)
Entity Type:Individual
Prefix:
First Name:LILLIAN
Middle Name:
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:LND, MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 AVE. PERIFERAL 1111-A
Mailing Address - Street 2:COND. CIUDAD UNIVERSITARIA
Mailing Address - City:TRUJILLO ALTO
Mailing Address - State:PR
Mailing Address - Zip Code:00976-2124
Mailing Address - Country:US
Mailing Address - Phone:787-374-1402
Mailing Address - Fax:
Practice Address - Street 1:1 AVE PERIFERAL 1111-A
Practice Address - Street 2:COND CUIDAD UNIVERSITARIA
Practice Address - City:TRUJILLO ALTO
Practice Address - State:PR
Practice Address - Zip Code:00976
Practice Address - Country:US
Practice Address - Phone:787-374-1402
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-01-21
Last Update Date:2009-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR460133NN1002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education