=====================================================
General NPI Number Information
=====================================================
NPI Number | 1376556845
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | NAYIP RODRIGUEZ PELLICIER OD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/14/2006
-----------------------------------------------------
Last Update Date | 08/26/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 34 CALLE BARBOSA
-----------------------------------------------------
City | CABO ROJO
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00623-3511
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-851-3800
-----------------------------------------------------
Fax | 787-851-3800
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 1332
-----------------------------------------------------
City | CABO ROJO
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00623-1332
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-691-3800
-----------------------------------------------------
Fax | 787-851-3800
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | 553
-----------------------------------------------------
License Number State | PR
-----------------------------------------------------