Provider Demographics
NPI:1427376532
Name:RODRIGUEZ, MADELINE (TEM)
Entity Type:Individual
Prefix:MISS
First Name:MADELINE
Middle Name:
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:TEM
Other - Prefix:MISS
Other - First Name:MADELINE
Other - Middle Name:
Other - Last Name:RODRIGUEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:TEM
Mailing Address - Street 1:RR 1 BOX 964
Mailing Address - Street 2:BO PLAYA CALLE CIPRES B-29
Mailing Address - City:ANASCO
Mailing Address - State:PR
Mailing Address - Zip Code:00610
Mailing Address - Country:US
Mailing Address - Phone:787-962-4706
Mailing Address - Fax:
Practice Address - Street 1:2325 AVE ALBIZU CAMPOS
Practice Address - Street 2:
Practice Address - City:RINCON
Practice Address - State:PR
Practice Address - Zip Code:00677-2432
Practice Address - Country:US
Practice Address - Phone:787-962-4706
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-13
Last Update Date:2010-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2092146L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes146L00000XEmergency Medical Service ProvidersEmergency Medical Technician, Paramedic