Healthcare Provider Details

I. General information

NPI: 1780789933
Provider Name (Legal Business Name): DR. ANGEL MANUEL RODRIGUEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/13/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1171 AVE DOS PALMAS LEVITTOWN
TOA BAJA PR
00949-4102
US

IV. Provider business mailing address

1171 AVE DOS PALMAS LEVITTOWN
TOA BAJA PR
00949-4102
US

V. Phone/Fax

Practice location:
  • Phone: 787-795-1546
  • Fax:
Mailing address:
  • Phone: 787-795-1546
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number1757
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: