Provider Demographics
NPI:1740508407
Name:RODRIGUEZ, MARITZA
Entity type:Individual
Prefix:MRS
First Name:MARITZA
Middle Name:
Last Name:RODRIGUEZ
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 111
Mailing Address - Street 2:
Mailing Address - City:YAUCO
Mailing Address - State:PR
Mailing Address - Zip Code:00698-0111
Mailing Address - Country:US
Mailing Address - Phone:787-856-7274
Mailing Address - Fax:
Practice Address - Street 1:BO. QUEBRADAS SECTOR JAVILLA
Practice Address - Street 2:KM. 3.0
Practice Address - City:YAUCO
Practice Address - State:PR
Practice Address - Zip Code:00698-0111
Practice Address - Country:US
Practice Address - Phone:787-856-7274
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-05
Last Update Date:2010-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR99471041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical