Healthcare Provider Details

I. General information

NPI: 1538126891
Provider Name (Legal Business Name): ANGEL D. RODRIGUEZ
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/28/2006
Last Update Date: 11/27/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

BO. TIJERAS CARR . # 14 K.M 17.3
JUANA DIAZ PR
00795-9750
US

IV. Provider business mailing address

HC 01 BOX 31240
JUANA DIAZ PR
00795-9750
US

V. Phone/Fax

Practice location:
  • Phone: 787-837-3098
  • Fax: 787-837-7198
Mailing address:
  • Phone: 787-837-3098
  • Fax: 787-837-7198

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code341600000X
TaxonomyAmbulance
License NumberTCAMB273
License Number StatePR

VIII. Authorized Official

Name: MR. ANGEL D RODRIGUEZ
Title or Position: OWNER
Credential:
Phone: 787-837-3098