Provider Demographics
NPI:1578876850
Name:RODRIGUEZ, NYDIA M (761)
Entity Type:Individual
Prefix:MRS
First Name:NYDIA
Middle Name:M
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:761
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 255
Mailing Address - Street 2:
Mailing Address - City:LUQUILLO
Mailing Address - State:PR
Mailing Address - Zip Code:00773-0255
Mailing Address - Country:US
Mailing Address - Phone:787-514-7696
Mailing Address - Fax:
Practice Address - Street 1:AVE.BARALT CALLE PRINCIPAL
Practice Address - Street 2:I-8
Practice Address - City:FAJARDO
Practice Address - State:PR
Practice Address - Zip Code:00738-0008
Practice Address - Country:US
Practice Address - Phone:787-514-7696
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-15
Last Update Date:2010-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR761156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician