=====================================================
General NPI Number Information
=====================================================
NPI Number | 1033427539
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | RAFAEL ANTONIO RODRIGUEZ SERRANO
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/17/2010
-----------------------------------------------------
Last Update Date | 11/29/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | HC-03 BOX 11943
-----------------------------------------------------
City | CAMUY
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00627
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-458-2644
-----------------------------------------------------
Fax | 787-544-6541
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | CARR #2 KM 94.2 INT BO YEGUADA
-----------------------------------------------------
City | CAMUY
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00627
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-458-2644
-----------------------------------------------------
Fax | 787-544-6541
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MR. RAFAEL A. RODRIGUEZ
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 787-458-2644
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3416L0300X
-----------------------------------------------------
Taxonomy Name | Land Ambulance
-----------------------------------------------------
License Number | TCAMB663
-----------------------------------------------------
License Number State | PR
-----------------------------------------------------