Provider Demographics
NPI:1316835804
Name:RODRIGUEZ ROBLES, MAYRA I
Entity type:Individual
Prefix:
First Name:MAYRA
Middle Name:I
Last Name:RODRIGUEZ ROBLES
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 1:211 NORTHCOAST VLG
Mailing Address - Street 2:
Mailing Address - City:VEGA ALTA
Mailing Address - State:PR
Mailing Address - Zip Code:00692-8713
Mailing Address - Country:US
Mailing Address - Phone:787-632-3735
Mailing Address - Fax:
Practice Address - Street 1:211 NORTHCOAST VLG
Practice Address - Street 2:
Practice Address - City:VEGA ALTA
Practice Address - State:PR
Practice Address - Zip Code:00692-8713
Practice Address - Country:US
Practice Address - Phone:787-632-3735
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-25
Last Update Date:2025-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR588235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist