Provider Demographics
NPI:1609086370
Name:RODRIGUEZ, MARISOL (OD)
Entity type:Individual
Prefix:
First Name:MARISOL
Middle Name:
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 CALLE ROBLES
Mailing Address - Street 2:LA CUMBRE
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00925-2919
Mailing Address - Country:US
Mailing Address - Phone:787-766-9376
Mailing Address - Fax:787-766-9376
Practice Address - Street 1:12 CALLE ROBLES
Practice Address - Street 2:
Practice Address - City:RIO PIEDRAS
Practice Address - State:PR
Practice Address - Zip Code:00925-2919
Practice Address - Country:US
Practice Address - Phone:787-766-9376
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2016-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR397152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist