Provider Demographics
NPI:1457033177
Name:RODRIGUEZ TORRES, KEISY NICOLE
Entity Type:Individual
Prefix:
First Name:KEISY
Middle Name:NICOLE
Last Name:RODRIGUEZ TORRES
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 1:378 CALLE ANDRES NARVAEZ
Mailing Address - Street 2:
Mailing Address - City:MOROVIS
Mailing Address - State:PR
Mailing Address - Zip Code:00687-2204
Mailing Address - Country:US
Mailing Address - Phone:787-346-6963
Mailing Address - Fax:
Practice Address - Street 1:378 CALLE ANDRES NARVAEZ
Practice Address - Street 2:
Practice Address - City:MOROVIS
Practice Address - State:PR
Practice Address - Zip Code:00687-2204
Practice Address - Country:US
Practice Address - Phone:787-346-6963
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-02
Last Update Date:2023-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3029390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program