Provider Demographics
NPI:1447098199
Name:RODRIGUEZ GUTIERREZ, AWILMARIE
Entity type:Individual
Prefix:
First Name:AWILMARIE
Middle Name:
Last Name:RODRIGUEZ GUTIERREZ
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:HC 43 BOX 11769
Mailing Address - Street 2:
Mailing Address - City:CAYEY
Mailing Address - State:PR
Mailing Address - Zip Code:00736-9226
Mailing Address - Country:US
Mailing Address - Phone:787-960-4405
Mailing Address - Fax:
Practice Address - Street 1:CIDRA PROFESSIONAL CENTER
Practice Address - Street 2:BO. ARENAS CARR. 734 KM. 0.5
Practice Address - City:CIDRA
Practice Address - State:PR
Practice Address - Zip Code:00739
Practice Address - Country:US
Practice Address - Phone:787-647-9967
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-17
Last Update Date:2024-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR0072572355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant