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General NPI Number Information
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NPI Number | 1083163596
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Entity Type | Organization
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Legal Business Name | DR ENRIQUE RODRIGUEZ DECLET LLC
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Dates
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Enumeration Date | 09/26/2016
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Last Update Date | 09/26/2016
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Provider Practice Location Address
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Address Line | C2 CALLE JOSE VILLARES URB PARADIS
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City | CAGUAS
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State | PR
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Zip | 00725
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Country | US
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Telephone | 178-762-6527
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Fax | 787-258-2545
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Provider Business Mailing Address
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Address Line | PO BOX 6059
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City | CAGUAS
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State | PR
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Zip | 00726-6059
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Country | US
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Telephone | 178-762-6527
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Fax | 787-258-2545
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Authorized Official
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Title or Position | MEMBER
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Name | DR. ENRIQUE RODRIGUEZ
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Credential | M.D.
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Telephone | 17876265272
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | 792
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License Number State | PR
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Taxonomy #2
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Taxonomy Code | 207VG0400X
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Taxonomy Name | Gynecology Physician
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License Number | 6248
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License Number State | PR
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