Healthcare Provider Details

I. General information

NPI: 1699552349
Provider Name (Legal Business Name): CARIBBEAN OPHTHALMOLOGY ASSOCIATES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2023
Last Update Date: 01/16/2024
Certification Date: 01/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1112 AVE JESUS T PINERO
SAN JUAN PR
00921-1722
US

IV. Provider business mailing address

995 CALLE QUITO
SAN JUAN PR
00921-2337
US

V. Phone/Fax

Practice location:
  • Phone: 787-781-3020
  • Fax:
Mailing address:
  • Phone: 787-514-4748
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. EDGAR ALEXIS DE JESUS RODRIGUEZ
Title or Position: PRESIDENT
Credential: MD
Phone: 787-514-4748