Provider Demographics
NPI:1710187414
Name:RODRIGUEZ-GONZALEZ, IRAIDA
Entity Type:Individual
Prefix:MISS
First Name:IRAIDA
Middle Name:
Last Name:RODRIGUEZ-GONZALEZ
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:HC 4 BOX 10515
Mailing Address - Street 2:
Mailing Address - City:UTUADO
Mailing Address - State:PR
Mailing Address - Zip Code:00641-9541
Mailing Address - Country:US
Mailing Address - Phone:787-894-2228
Mailing Address - Fax:
Practice Address - Street 1:HC 4 BOX 10515
Practice Address - Street 2:
Practice Address - City:UTUADO
Practice Address - State:PR
Practice Address - Zip Code:00641-9541
Practice Address - Country:US
Practice Address - Phone:787-894-2228
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-20
Last Update Date:2007-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4619183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist