=====================================================
General NPI Number Information
=====================================================
NPI Number | 1205660826
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CRISTOPHER RODRIGUEZ SUAREZ
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/27/2024
-----------------------------------------------------
Last Update Date | 08/27/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2020 AVE BORINQUEN
-----------------------------------------------------
City | SANJUAN
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00915-3822
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-268-4171
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 320 VIA LA MANSION URB MANSIONES DEL LAGO
-----------------------------------------------------
City | TOA BAJA
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00949-3265
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-447-1718
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174H00000X
-----------------------------------------------------
Taxonomy Name | Health Educator
-----------------------------------------------------
License Number | 1027
-----------------------------------------------------
License Number State | PR
-----------------------------------------------------