Provider Demographics
NPI:1336637735
Name:RODRIGUEZ IRIZARRY, NADYA ALEXANDRA
Entity Type:Individual
Prefix:
First Name:NADYA
Middle Name:ALEXANDRA
Last Name:RODRIGUEZ IRIZARRY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2141
Mailing Address - Street 2:
Mailing Address - City:AGUADILLA
Mailing Address - State:PR
Mailing Address - Zip Code:00605-2141
Mailing Address - Country:US
Mailing Address - Phone:787-214-2952
Mailing Address - Fax:
Practice Address - Street 1:PR-411 KM 0.9 AVE. NATIVO ALERS
Practice Address - Street 2:EDIFICIO MAGNOLIA SUITE 1
Practice Address - City:AGUADA
Practice Address - State:PR
Practice Address - Zip Code:00602
Practice Address - Country:US
Practice Address - Phone:787-214-2952
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-01
Last Update Date:2018-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR200681041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical