=====================================================
General NPI Number Information
=====================================================
NPI Number | 1871598599
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MANUEL A RODRIGUEZ RIOS M.D., A.B.M.C.M.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/17/2005
-----------------------------------------------------
Last Update Date | 05/22/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | BUENA VISTA AVENUE # 5 SUITE 1
-----------------------------------------------------
City | MOROVIS
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00687
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-862-3035
-----------------------------------------------------
Fax | 787-862-3035
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 953
-----------------------------------------------------
City | MOROVIS
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00687-0953
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-862-3035
-----------------------------------------------------
Fax | 787-862-3035
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | 007320
-----------------------------------------------------
License Number State | PR
-----------------------------------------------------