Healthcare Provider Details

I. General information

NPI: 1417607458
Provider Name (Legal Business Name): CARLOS J RODRIGUEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/24/2022
Last Update Date: 03/24/2022
Certification Date: 03/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARR 111 KM 46.6 BO. ANGELES
UTUADO PR
00641
US

IV. Provider business mailing address

HC 4 BOX 17195
LARES PR
00669-9489
US

V. Phone/Fax

Practice location:
  • Phone: 787-514-1360
  • Fax:
Mailing address:
  • Phone: 787-514-1360
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: