Healthcare Provider Details

I. General information

NPI: 1174058077
Provider Name (Legal Business Name): PABLO RODRIGUEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/28/2017
Last Update Date: 04/28/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

RR 7 BOX 17163
TOA ALTA PR
00953-8846
US

IV. Provider business mailing address

RR 7 BOX 17163
TOA ALTA PR
00953-8846
US

V. Phone/Fax

Practice location:
  • Phone: 939-337-3798
  • Fax:
Mailing address:
  • Phone: 939-337-3798
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2279G1100X
TaxonomyGeneral Care Registered Respiratory Therapist
License Number1629219
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: