Provider Demographics
NPI:1376640722
Name:RODRIGUEZ COUTO, MILAGROS E (MT)
Entity Type:Individual
Prefix:
First Name:MILAGROS
Middle Name:E
Last Name:RODRIGUEZ COUTO
Suffix:
Gender:F
Credentials:MT
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 96
Mailing Address - Street 2:
Mailing Address - City:ENSENADA
Mailing Address - State:PR
Mailing Address - Zip Code:00647-0096
Mailing Address - Country:US
Mailing Address - Phone:787-821-3008
Mailing Address - Fax:787-821-3008
Practice Address - Street 1:LAJAS ROAD 25 B
Practice Address - Street 2:
Practice Address - City:ENSENADA
Practice Address - State:PR
Practice Address - Zip Code:00647
Practice Address - Country:US
Practice Address - Phone:787-821-3008
Practice Address - Fax:787-821-3008
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR583246RM2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246RM2200XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyMedical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
0038327Medicare ID - Type Unspecified
X15816Medicare UPIN