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General NPI Number Information
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NPI Number | 1790218162
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Entity Type | Individual
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Provider Name | EDGAR ALEXIS DE JESUS RODRIGUEZ MD
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Gender | Male
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Dates
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Enumeration Date | 04/04/2017
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Last Update Date | 06/08/2023
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Provider Practice Location Address
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Address Line | CENTRO MEDICO DE PUERTO RICO BARRIO MONACILLOS
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City | SAN JUAN
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State | PR
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Zip | 00935-7514
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Country | US
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Telephone | 787-777-3535
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 365067
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City | SAN JUAN
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State | PR
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Zip | 00936-5067
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Country | US
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Telephone | 787-777-3535
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Fax |
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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 | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | 22806
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License Number State | PR
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