Provider Demographics
NPI:1790026276
Name:RODRIGUEZ, MARIJINIA (OTL)
Entity Type:Individual
Prefix:
First Name:MARIJINIA
Middle Name:
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:OTL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CALLE QUIROZ BUZON 10 COVADONGA
Mailing Address - Street 2:
Mailing Address - City:TOA BAJA
Mailing Address - State:PUERTO RICO
Mailing Address - Zip Code:00949
Mailing Address - Country:UM
Mailing Address - Phone:787-431-7607
Mailing Address - Fax:
Practice Address - Street 1:CALLE QUIROZ BUZON 10 COVADONGA
Practice Address - Street 2:
Practice Address - City:TOA BAJA
Practice Address - State:PUERTO RICO
Practice Address - Zip Code:00949
Practice Address - Country:UM
Practice Address - Phone:787-431-7607
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-03-08
Last Update Date:2013-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR788225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist