Provider Demographics
NPI:1780856542
Name:RODRIGUEZ, MARIELA DEL CARMEN (LND, RD)
Entity Type:Individual
Prefix:
First Name:MARIELA
Middle Name:DEL CARMEN
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:LND, RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1306 AVE MONTE CARLO APT 236
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00924-5737
Mailing Address - Country:US
Mailing Address - Phone:787-249-6926
Mailing Address - Fax:787-708-2260
Practice Address - Street 1:CALLE 3 KM 8.4
Practice Address - Street 2:PASEO DEL PRADO SHOPPING CENTER SEGUNDO PISO
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00987
Practice Address - Country:US
Practice Address - Phone:787-710-2532
Practice Address - Fax:787-750-2830
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-01
Last Update Date:2016-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1191133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered