Provider Demographics
NPI:1275794265
Name:RODRIGUEZ, IRMA A (MS)
Entity Type:Individual
Prefix:MRS
First Name:IRMA
Middle Name:A
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:777 CALLE LOS INGENIEROS
Mailing Address - Street 2:BO ALGARROBO
Mailing Address - City:MAYAGUEZ
Mailing Address - State:PR
Mailing Address - Zip Code:00682-7708
Mailing Address - Country:US
Mailing Address - Phone:787-405-0901
Mailing Address - Fax:
Practice Address - Street 1:777 CALLE LOS INGENIEROS
Practice Address - Street 2:BO ALGARROBO
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00682-7708
Practice Address - Country:US
Practice Address - Phone:787-405-0901
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-23
Last Update Date:2008-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR326235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist