Provider Demographics
NPI:1548736101
Name:RODRIGUEZ-ASENCIO, GLADIMAR
Entity Type:Individual
Prefix:
First Name:GLADIMAR
Middle Name:
Last Name:RODRIGUEZ-ASENCIO
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:PO BOX 267
Mailing Address - Street 2:
Mailing Address - City:CABO ROJO
Mailing Address - State:PR
Mailing Address - Zip Code:00623-0267
Mailing Address - Country:US
Mailing Address - Phone:787-517-5782
Mailing Address - Fax:
Practice Address - Street 1:396 LUIS F. SALA ZONA INDUSTRIAL 2
Practice Address - Street 2:
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00716-2347
Practice Address - Country:US
Practice Address - Phone:787-812-2525
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-22
Last Update Date:2018-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program