Healthcare Provider Details

I. General information

NPI: 1649001777
Provider Name (Legal Business Name): KEISEL RODRIGUEZ LEZCANO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2024
Last Update Date: 10/09/2025
Certification Date: 10/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 30532
MANATI PR
00674-8513
US

IV. Provider business mailing address

PO BOX 30532
MANATI PR
00674-8513
US

V. Phone/Fax

Practice location:
  • Phone: 787-621-3322
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number37609-R
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: