Healthcare Provider Details

I. General information

NPI: 1750595070
Provider Name (Legal Business Name): TED OCASIO RODRIGUEZ 1742P
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/09/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

90 CALLE SAN MARTIN
GUAYNABO PR
00968-1400
US

IV. Provider business mailing address

PO BOX 2161
SAN JUAN PR
00922-2161
US

V. Phone/Fax

Practice location:
  • Phone: 787-754-2550
  • Fax: 787-781-2063
Mailing address:
  • Phone: 787-754-2550
  • Fax: 787-781-2063

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code146L00000X
TaxonomyParamedic
License Number1742P
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: