Provider Demographics
NPI:1356469829
Name:RODRIGUEZ FLORES, ISAIS E
Entity Type:Individual
Prefix:
First Name:ISAIS
Middle Name:E
Last Name:RODRIGUEZ FLORES
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 1:206 CALLE LEON
Mailing Address - Street 2:BUEN CONSEJO
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926-1615
Mailing Address - Country:US
Mailing Address - Phone:787-635-1176
Mailing Address - Fax:
Practice Address - Street 1:206 CALLE LEON
Practice Address - Street 2:BUEN CONSEJO
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00926-1615
Practice Address - Country:US
Practice Address - Phone:787-635-1176
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR005510183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician