Healthcare Provider Details

I. General information

NPI: 1871645630
Provider Name (Legal Business Name): DR. RODRIGUEZ SANTANA CSP.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/18/2007
Last Update Date: 06/18/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 AVE FELIX ALDARONDO
ISABELA PR
00662-5941
US

IV. Provider business mailing address

PO BOX 1283
ISABELA PR
00662-1283
US

V. Phone/Fax

Practice location:
  • Phone: 787-872-3730
  • Fax: 787-872-3733
Mailing address:
  • Phone: 787-872-3730
  • Fax: 787-872-3733

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QE0002X
TaxonomyEmergency Care Clinic/Center
License Number14525
License Number StatePR
# 2
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number14525
License Number StatePR
# 3
Primary TaxonomyN
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number14525
License Number StatePR
# 4
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number14525
License Number StatePR

VII. Legacy identifiers

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

VIII. Authorized Official

Name: DR. ANIBAL RODRIGUEZ
Title or Position: PRESIDENT
Credential: M.D.
Phone: 787-431-8426