Provider Demographics
NPI:1851648109
Name:RODRIGUEZ-NOLASCO, EDNALITH
Entity Type:Individual
Prefix:MRS
First Name:EDNALITH
Middle Name:
Last Name:RODRIGUEZ-NOLASCO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1141 FOREST AVE APT 3
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10456-5492
Mailing Address - Country:US
Mailing Address - Phone:646-359-0105
Mailing Address - Fax:
Practice Address - Street 1:1141 FOREST AVE APT 3
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10456-5492
Practice Address - Country:US
Practice Address - Phone:646-359-0105
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-06
Last Update Date:2012-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY620315121174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist