Provider Demographics
NPI:1821362724
Name:RODRIGUEZ, IRIS B (LND, RD)
Entity Type:Individual
Prefix:
First Name:IRIS
Middle Name:B
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:HC 10 BOX 49842
Mailing Address - Street 2:
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00725-9687
Mailing Address - Country:US
Mailing Address - Phone:787-286-9117
Mailing Address - Fax:
Practice Address - Street 1:HC 10 BOX 49842
Practice Address - Street 2:BO. SAN SALVADOR
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725-9687
Practice Address - Country:US
Practice Address - Phone:787-286-9117
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-24
Last Update Date:2012-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1466133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist