Provider Demographics
NPI:1790822849
Name:RODRIGUEZ, MARITZA (PHB)
Entity Type:Individual
Prefix:MRS
First Name:MARITZA
Middle Name:
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:PHB
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:ESTANCIAS DE MANATI #153 DORADO ST.
Mailing Address - Street 2:
Mailing Address - City:MANATI
Mailing Address - State:PR
Mailing Address - Zip Code:00674
Mailing Address - Country:US
Mailing Address - Phone:787-399-3237
Mailing Address - Fax:787-854-7265
Practice Address - Street 1:ROAD #2 PLAZA PUERTA DEL SOL
Practice Address - Street 2:SUITE #3
Practice Address - City:MANATI
Practice Address - State:PR
Practice Address - Zip Code:00674
Practice Address - Country:US
Practice Address - Phone:787-884-4445
Practice Address - Fax:787-884-4444
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3920183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist