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General NPI Number Information
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NPI Number | 1952384877
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Entity Type | Individual
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Provider Name | CARLOS J RODRIGUEZ MATEO MD
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Gender | Male
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Dates
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Enumeration Date | 11/23/2005
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Last Update Date | 10/22/2012
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Provider Practice Location Address
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Address Line | 58 CALLE BARBOSA BO COQUI
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City | AGUIRRE
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State | PR
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Zip | 00704-2420
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Country | US
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Telephone | 787-824-6395
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Fax | 787-824-7655
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Provider Business Mailing Address
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Address Line | PO BOX 424
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City | AGUIRRE
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State | PR
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Zip | 00704-0424
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Country | US
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Telephone | 787-824-6395
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Fax | 787-824-1200
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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 | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | 10434
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License Number State | PR
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