Provider Demographics
NPI:1972698843
Name:RODRIGUEZ, MILDRED SUSANA (BSPT / MPHE)
Entity Type:Individual
Prefix:
First Name:MILDRED
Middle Name:SUSANA
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:BSPT / MPHE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:47TH ST SW #869 LAS LOMAS
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00920
Mailing Address - Country:US
Mailing Address - Phone:787-450-8811
Mailing Address - Fax:787-720-7691
Practice Address - Street 1:RR #3 BOX 3962
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00926-9614
Practice Address - Country:US
Practice Address - Phone:787-450-8811
Practice Address - Fax:787-720-7691
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR280101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor