Healthcare Provider Details

I. General information

NPI: 1861773244
Provider Name (Legal Business Name): MR. MARCOS GERARDO SANTOS RODRIGUEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/30/2011
Last Update Date: 11/07/2023
Certification Date: 11/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CALLE C A-1 REPARTO MONTELLANO
CAYEY PR
00737-1990
US

IV. Provider business mailing address

PO BOX 371990
CAYEY PR
00737-1990
US

V. Phone/Fax

Practice location:
  • Phone: 787-402-7428
  • Fax:
Mailing address:
  • Phone: 787-402-7428
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number11798
License Number StatePR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: