Healthcare Provider Details

I. General information

NPI: 1255715975
Provider Name (Legal Business Name): RODRIGO NINO NUNEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/13/2015
Last Update Date: 07/13/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 BO MONACILLO AMERICO MIRANDA AVE AREA DE CENTRO MEDICO METROPOLITANO
SAN JUAN PR
00935-0001
US

IV. Provider business mailing address

14 CALLE BALDORIOTY APT 202
CAGUAS PR
00725-3506
US

V. Phone/Fax

Practice location:
  • Phone: 787-421-5594
  • Fax:
Mailing address:
  • Phone: 787-421-5594
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246QM0706X
TaxonomyMedical Technologist
License Number8369
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: