Healthcare Provider Details

I. General information

NPI: 1891736997
Provider Name (Legal Business Name): CARLOS RUBEN GARCIA RODRIGUEZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2006
Last Update Date: 11/30/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 AVE FD ROOSEVELT EDIF CLINICA LAS AMERICAS OFIC 205
SAN JUAN PR
00918-2103
US

IV. Provider business mailing address

EDIF CLINICA LAS AMERICAS OFIC 205 AVE. ROOSEVELT #400
SAN JUAN PR
00918
US

V. Phone/Fax

Practice location:
  • Phone: 787-765-1919
  • Fax: 787-763-4049
Mailing address:
  • Phone: 787-765-1919
  • Fax: 787-763-4049

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number13628
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: