Provider Demographics
NPI:1376894642
Name:RODRIGUEZ, YEIS ENID (PH)
Entity Type:Individual
Prefix:MRS
First Name:YEIS
Middle Name:ENID
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:PH
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 1091
Mailing Address - Street 2:
Mailing Address - City:YABUCOA
Mailing Address - State:PUERTO RICO
Mailing Address - Zip Code:00767
Mailing Address - Country:UM
Mailing Address - Phone:787-380-5731
Mailing Address - Fax:
Practice Address - Street 1:URB. ALTURAS DE TERRALINDA CALLE AMAPOLA
Practice Address - Street 2:CASA B3 BO. AGUACATE
Practice Address - City:YABUCOA
Practice Address - State:PR
Practice Address - Zip Code:00767
Practice Address - Country:US
Practice Address - Phone:787-380-5731
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-27
Last Update Date:2012-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR7598183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician