Provider Demographics
NPI:1356657316
Name:RODRIGUEZ, IDA L (RN)
Entity Type:Individual
Prefix:
First Name:IDA
Middle Name:L
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:C10 CALLE AMAPOLA
Mailing Address - Street 2:EXT.CAMPO ALEGRE
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00956-4433
Mailing Address - Country:US
Mailing Address - Phone:787-647-2286
Mailing Address - Fax:
Practice Address - Street 1:C10 CALLE AMAPOLA
Practice Address - Street 2:EXT.CAMPO ALEGRE
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00956-4433
Practice Address - Country:US
Practice Address - Phone:787-647-2286
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-27
Last Update Date:2010-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR20233163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse