Provider Demographics
NPI:1346417839
Name:RODRIGUEZ, JOVINA (OD)
Entity Type:Individual
Prefix:MRS
First Name:JOVINA
Middle Name:
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:BARRIO DAGUAO
Mailing Address - Street 2:BUZON 738
Mailing Address - City:NAGUABO
Mailing Address - State:PUERTO RICO
Mailing Address - Zip Code:00718
Mailing Address - Country:UM
Mailing Address - Phone:787-206-2410
Mailing Address - Fax:
Practice Address - Street 1:OPTICA SEARS PLAZA DEL ESTE SHOPPING CENTER
Practice Address - Street 2:
Practice Address - City:FAJARDO
Practice Address - State:PUESRTO RICO
Practice Address - Zip Code:00738
Practice Address - Country:UM
Practice Address - Phone:787-863-2590
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-13
Last Update Date:2008-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR487152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist