Healthcare Provider Details

I. General information

NPI: 1821595489
Provider Name (Legal Business Name): CARLOS A RODRIGUEZ CHAMORRO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/10/2018
Last Update Date: 04/10/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8169 CALLE CONCORDIA 412 CONDOMINIO SAN VICENTE
PONCE PR
00717
US

IV. Provider business mailing address

HC 3 BOX 10914
JUANA DIAZ PR
00795-9851
US

V. Phone/Fax

Practice location:
  • Phone: 787-284-5884
  • Fax: 787-284-5874
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: