Provider Demographics
NPI:1790315497
Name:RODRIGUEZ, CRISTINA MARIA (LND)
Entity Type:Individual
Prefix:
First Name:CRISTINA
Middle Name:MARIA
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 302
Mailing Address - Street 2:
Mailing Address - City:CAMUY
Mailing Address - State:PR
Mailing Address - Zip Code:00627-0302
Mailing Address - Country:US
Mailing Address - Phone:787-356-9983
Mailing Address - Fax:
Practice Address - Street 1:CARRETERA 129 KM 1.0 AVENIDA SAN LUIS
Practice Address - Street 2:HOSPITAL CAYETANO COLL Y TOSTE
Practice Address - City:ARECIBO
Practice Address - State:PR
Practice Address - Zip Code:00612
Practice Address - Country:US
Practice Address - Phone:787-650-7272
Practice Address - Fax:787-650-7248
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-22
Last Update Date:2020-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2123133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist