Healthcare Provider Details

I. General information

NPI: 1356882302
Provider Name (Legal Business Name): OSWALDO RODRIGUEZ CP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/10/2017
Last Update Date: 03/10/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

840 CALLE ZAFIRO
SAN JUAN PR
00926-5825
US

IV. Provider business mailing address

840 CALLE ZAFIRO
SAN JUAN PR
00926-5825
US

V. Phone/Fax

Practice location:
  • Phone: 787-368-8267
  • Fax:
Mailing address:
  • Phone: 787-368-8267
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1744P3200X
TaxonomyProsthetics Case Management
License NumberC22525
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: