Healthcare Provider Details

I. General information

NPI: 1316141534
Provider Name (Legal Business Name): RODOLFO ELIAS ALCEDO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2007
Last Update Date: 09/30/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CAMELOT CONDOMINIUM NUMBER 140 STREET 842 APARTMENT 3103
SAN JUAN PR
00926
US

IV. Provider business mailing address

75 FRANCIS STREET NEUROLOGICAL SURGERY RESIDENCY TRAINING PROGRAM
BOSTON MA
02115
US

V. Phone/Fax

Practice location:
  • Phone: 787-777-3535
  • Fax:
Mailing address:
  • Phone: 617-732-8719
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number88E
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: