Provider Demographics
NPI:1295891992
Name:RODRIGUEZ, CELIBERMARI (LND, RD)
Entity type:Individual
Prefix:
First Name:CELIBERMARI
Middle Name:
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 1:225 CALLE 9
Mailing Address - Street 2:BRISAS DE CEIBA
Mailing Address - City:CEIBA
Mailing Address - State:PR
Mailing Address - Zip Code:00735-3120
Mailing Address - Country:US
Mailing Address - Phone:787-475-3792
Mailing Address - Fax:
Practice Address - Street 1:225 CALLE 9
Practice Address - Street 2:BRISAS DE CEIBA
Practice Address - City:CEIBA
Practice Address - State:PR
Practice Address - Zip Code:00735
Practice Address - Country:US
Practice Address - Phone:787-475-3792
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1420133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR4302481OtherDRIVERS LICENCE