Provider Demographics
NPI:1699189480
Name:RODRIGUEZ, YANIL M (LND)
Entity Type:Individual
Prefix:MRS
First Name:YANIL
Middle Name:M
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:LND
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 1777
Mailing Address - Street 2:
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00970-1777
Mailing Address - Country:US
Mailing Address - Phone:787-424-5128
Mailing Address - Fax:787-200-4415
Practice Address - Street 1:1790 JULIO AYBAR STREET, SANTIAGO IGLESIAS
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00921
Practice Address - Country:US
Practice Address - Phone:787-424-5128
Practice Address - Fax:787-200-4415
Is Sole Proprietor?:No
Enumeration Date:2014-06-19
Last Update Date:2014-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1606133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist