Provider Demographics
NPI:1619307808
Name:RODRIGUEZ, BERTHA ISEL (RN)
Entity Type:Individual
Prefix:MS
First Name:BERTHA
Middle Name:ISEL
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14885 SW 25TH LN
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33185-5635
Mailing Address - Country:US
Mailing Address - Phone:305-819-6300
Mailing Address - Fax:305-318-8875
Practice Address - Street 1:975 W 49TH ST
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-3412
Practice Address - Country:US
Practice Address - Phone:305-819-6300
Practice Address - Fax:305-818-8875
Is Sole Proprietor?:No
Enumeration Date:2013-11-25
Last Update Date:2013-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9336533163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse