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General NPI Number Information
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NPI Number | 1114341112
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Entity Type | Organization
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Legal Business Name | WRR ELITE MEDICAL GROUP CSP
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Dates
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Enumeration Date | 02/11/2014
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Last Update Date | 02/11/2014
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Provider Practice Location Address
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Address Line | CALLE 531 QJ17 COUNTRY CLUB
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City | CAROLINA
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State | PR
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Zip | 00982
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Country | US
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Telephone | 787-376-4168
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Fax | 787-999-0077
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Provider Business Mailing Address
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Address Line | PO BOX 2939
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City | CAROLINA
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State | PR
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Zip | 00984-2939
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Country | US
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Telephone | 787-376-4168
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Fax | 787-999-0077
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. WILBERT RODRIGUEZ
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Credential | MD
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Telephone | 787-376-4168
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | 17652
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License Number State | PR
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