=====================================================
General NPI Number Information
=====================================================
NPI Number | 1215200837
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | RD MEDICAL CORPORATION
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/13/2012
-----------------------------------------------------
Last Update Date | 02/13/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | CALLE-MATIAS BRUGMAN SUITE-1 #82
-----------------------------------------------------
City | LAS MARIAS
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00670
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-827-1110
-----------------------------------------------------
Fax | 787-827-1110
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | HC03 BOX-37764
-----------------------------------------------------
City | MAYAGUEZ
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00680
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | FAMILY PRACTICE
-----------------------------------------------------
Name | NORBERTO ORTIZ CASTRO
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 787-827-1110
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | 13218
-----------------------------------------------------
License Number State | PR
-----------------------------------------------------