Provider Demographics
NPI:1861823254
Name:RODRIGUEZ CENTENO, GISELA
Entity Type:Individual
Prefix:
First Name:GISELA
Middle Name:
Last Name:RODRIGUEZ CENTENO
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:PO BOX 432
Mailing Address - Street 2:
Mailing Address - City:BAJADERO
Mailing Address - State:PR
Mailing Address - Zip Code:00616-0432
Mailing Address - Country:US
Mailing Address - Phone:787-505-8803
Mailing Address - Fax:787-895-6173
Practice Address - Street 1:CARR 2 BO COCOS KM99
Practice Address - Street 2:
Practice Address - City:QUEBRADILLAS
Practice Address - State:PR
Practice Address - Zip Code:00678-0001
Practice Address - Country:US
Practice Address - Phone:787-895-6173
Practice Address - Fax:787-895-6173
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-10
Last Update Date:2013-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR6363246Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246Z00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, Other
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR6363OtherLIC