Provider Demographics
NPI:1538295159
Name:RODRIGUEZ-TORRES, ISONELIE (OD)
Entity Type:Individual
Prefix:DR
First Name:ISONELIE
Middle Name:
Last Name:RODRIGUEZ-TORRES
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2320 E BASELINE RD
Mailing Address - Street 2:SUITE #145
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85042-6951
Mailing Address - Country:US
Mailing Address - Phone:602-243-9455
Mailing Address - Fax:602-243-5888
Practice Address - Street 1:2320 E BASELINE RD
Practice Address - Street 2:SUITE #145
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85042-6951
Practice Address - Country:US
Practice Address - Phone:602-243-9455
Practice Address - Fax:602-243-5888
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1273152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ101962Medicaid
AZU98042Medicare UPIN