MEDICARE: MR. HECTOR LUIS RODRIGUEZ MSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	10256	PR

General Provider Information

NPI Number	:	1083044366
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. HECTOR LUIS RODRIGUEZ MSW

Provider Business Mailing Address
First Line	:	COND CRYSTAL HOUSE
Second Line	:	601
City	:	SAN JUAN
State	:	PR
Zip	:	00923-2916
Country	:	US
Telephone Number	:	939-644-5783
Fax Number	:

Provider Business Practice Location Address
First Line	:	COND CRYSTAL HOUSE
Second Line	:	601
City	:	SAN JUAN
State	:	PR
Zip	:	00923-2916
Country	:	US
Telephone Number	:	939-644-5783
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/22/2013
Last Update Date	:	11/22/2013

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