Provider Demographics
NPI:1932300712
Name:RODRIGUEZ, ENEIDA (LPN)
Entity Type:Individual
Prefix:MRS
First Name:ENEIDA
Middle Name:
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:BO. MATUYA BAJO
Mailing Address - Street 2:HC01 BOX 4007
Mailing Address - City:MAUNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00707
Mailing Address - Country:US
Mailing Address - Phone:787-365-5089
Mailing Address - Fax:
Practice Address - Street 1:AVE. KENNEDY
Practice Address - Street 2:8
Practice Address - City:MAUNABO
Practice Address - State:PR
Practice Address - Zip Code:00707
Practice Address - Country:US
Practice Address - Phone:787-861-1407
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR18175164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse