Healthcare Provider Details

I. General information

NPI: 1053841932
Provider Name (Legal Business Name): MARTA E RODRIGUEZ CASTRO RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/14/2017
Last Update Date: 06/14/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

396 CALLE DR LUIS F SALA
PONCE PR
00716
US

IV. Provider business mailing address

A7 CALLE CEIBA URB MANSIONES DEL SUR
PONCE PR
00780
US

V. Phone/Fax

Practice location:
  • Phone: 787-840-0052
  • Fax:
Mailing address:
  • Phone: 787-361-3385
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number15271
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: