Healthcare Provider Details

I. General information

NPI: 1033487764
Provider Name (Legal Business Name): MR. JOSE CARLOS RODRIGUEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/08/2011
Last Update Date: 12/08/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CALLE JOSE MENDEZ CARDONA NUM.3 APARTADO 486
SAN SEBASTIAN PR
00665
US

IV. Provider business mailing address

HC 3 BOX 9028
MOCA PR
00676-9263
US

V. Phone/Fax

Practice location:
  • Phone: 787-896-1850
  • Fax:
Mailing address:
  • Phone: 787-830-5289
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number007964
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: