Provider Demographics
NPI:1487186771
Name:RODRIGUEZ, JULIA ENID
Entity Type:Individual
Prefix:
First Name:JULIA ENID
Middle Name:
Last Name:RODRIGUEZ
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 1:495 FLATBUSH AVE
Mailing Address - Street 2:
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06106-3601
Mailing Address - Country:US
Mailing Address - Phone:860-953-0830
Mailing Address - Fax:860-953-0862
Practice Address - Street 1:495 FLATBUSH AVE
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06106-3601
Practice Address - Country:US
Practice Address - Phone:860-953-0830
Practice Address - Fax:860-953-0862
Is Sole Proprietor?:No
Enumeration Date:2017-03-28
Last Update Date:2017-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001691156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician