Healthcare Provider Details

I. General information

NPI: 1437730322
Provider Name (Legal Business Name): NIKITAS PABLO RODRIGUEZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/21/2021
Last Update Date: 10/12/2023
Certification Date: 08/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PASEO DR. JOSE CELSO BARBOSA
SAN JUAN PR
00936
US

IV. Provider business mailing address

B COND JARD DE SAN IGNACIO APT 811B
SAN JUAN PR
00927-7017
US

V. Phone/Fax

Practice location:
  • Phone: 787-758-2525
  • Fax:
Mailing address:
  • Phone: 787-603-6712
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License Number23421
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: