Provider Demographics
NPI:1912137837
Name:RODRIGUEZ, VIRGINIA LUISA
Entity Type:Individual
Prefix:
First Name:VIRGINIA
Middle Name:LUISA
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 1:87 CALLE LEO
Mailing Address - Street 2:
Mailing Address - City:CANOVANAS
Mailing Address - State:PR
Mailing Address - Zip Code:00729-2979
Mailing Address - Country:US
Mailing Address - Phone:787-501-7087
Mailing Address - Fax:
Practice Address - Street 1:#615 AVE MANUEL PAVIA
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00909
Practice Address - Country:US
Practice Address - Phone:787-722-3600
Practice Address - Fax:787-722-6555
Is Sole Proprietor?:No
Enumeration Date:2009-07-27
Last Update Date:2024-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR8051183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician