Provider Demographics
NPI:1629843131
Name:RODRIGUEZ RAMOS, MAGDA ENID
Entity Type:Individual
Prefix:
First Name:MAGDA
Middle Name:ENID
Last Name:RODRIGUEZ RAMOS
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 1:215 OLD COLLEGE PL
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN HOME
Mailing Address - State:AR
Mailing Address - Zip Code:72653-3989
Mailing Address - Country:US
Mailing Address - Phone:787-397-1413
Mailing Address - Fax:
Practice Address - Street 1:624 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:MOUNTAIN HOME
Practice Address - State:AR
Practice Address - Zip Code:72653-2955
Practice Address - Country:US
Practice Address - Phone:870-424-8525
Practice Address - Fax:870-508-1355
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-15
Last Update Date:2023-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR1759133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered