Healthcare Provider Details

I. General information

NPI: 1750817573
Provider Name (Legal Business Name): OMAR E RODRIGUEZ ALEJANDRO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2017
Last Update Date: 10/17/2023
Certification Date: 10/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

UPR MEDICAL SCIENCES CAMPUS, DEPARTMENT OF SURGERY-ORTHOPAEDICS
SAN JUAN PR
00936-5067
US

IV. Provider business mailing address

PO BOX 365067 DEPARTMENT OF SURGERY-ORTHOPAEDICS UPR MEDICAL SCIENCES CAMPUS,
SAN JUAN PR
00936-5067
US

V. Phone/Fax

Practice location:
  • Phone: 787-764-5095
  • Fax:
Mailing address:
  • Phone: 787-764-5095
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number33974
License Number StatePR
# 2
Primary TaxonomyY
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License Number35.148364
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: