Provider Demographics
NPI:1881087591
Name:RODRIGUEZ, VIVIANA
Entity type:Individual
Prefix:
First Name:VIVIANA
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 1:73 CALLE SANTA CRUZ
Mailing Address - Street 2:SUITE 310
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00961-6910
Mailing Address - Country:US
Mailing Address - Phone:787-778-1294
Mailing Address - Fax:
Practice Address - Street 1:73 CALLE SANTA CRUZ
Practice Address - Street 2:SUITE 310
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00961-6910
Practice Address - Country:US
Practice Address - Phone:787-778-1294
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-05
Last Update Date:2015-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator