Healthcare Provider Details

I. General information

NPI: 1720996564
Provider Name (Legal Business Name): MARTIN RODRIGUEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/01/2026
Last Update Date: 09/01/2026
Certification Date: 08/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

997 CALLE SAN ROBERTO
SAN JUAN PR
00926-2759
US

IV. Provider business mailing address

CONDOMINIOS PARK VIEW TERRACE EDF 11 APT 401 LOIZA VALLEY
CANOVANAS PR
00729
US

V. Phone/Fax

Practice location:
  • Phone: 787-773-6583
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: