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General NPI Number Information
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NPI Number | 1407921760
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Entity Type | Individual
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Provider Name | RAFAEL RODRIGUEZ M.D.
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Gender | Male
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Dates
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Enumeration Date | 11/22/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | PMB SUITE 145 AVE. 90 RIO HONDO
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City | BAYAMON
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State | PR
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Zip | 00961-3113
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Country | US
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Telephone | 787-378-1040
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Fax |
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Provider Business Mailing Address
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Address Line | 110 ESMERALDA CIELO DORADO VILLAGE
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City | VEGA ALTA
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State | PR
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Zip | 00692
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Country | US
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Telephone | 787-270-1506
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Fax | 787-870-1508
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 08088
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License Number State | PR
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