Healthcare Provider Details

I. General information

NPI: 1548487234
Provider Name (Legal Business Name): OSCAR EMILIO RODRIGUEZ LOPEZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/20/2007
Last Update Date: 09/28/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

GENOVA STREET, G-31 EXTENSION VILLA CAPARRA
GUAYNABO PR
00966-1730
US

IV. Provider business mailing address

GENOVA STREET, G-31 EXTENSION VILLA CAPARRA
GUAYNABO PR
00966-1730
US

V. Phone/Fax

Practice location:
  • Phone: 787-630-1525
  • Fax: 787-793-1913
Mailing address:
  • Phone: 787-630-1525
  • Fax: 787-793-1913

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080H0002X
TaxonomyPediatric Hospice and Palliative Medicine Physician
License Number4810
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: