Healthcare Provider Details

I. General information

NPI: 1598085623
Provider Name (Legal Business Name): DAVID RODRIGUEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/11/2010
Last Update Date: 06/11/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

AVE HECTOR LA VILLA BO. SABANA HOYOS
ARECIBO PR
00688
US

IV. Provider business mailing address

HC 2 BOX 6580
BAJADERO PR
00616-9762
US

V. Phone/Fax

Practice location:
  • Phone: 787-881-4626
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: