MEDICARE: NIEVES RODRIGUEZ D.O.

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	156FX1800X	Optician	43	PR

General Provider Information

NPI Number	:	1831253046
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NIEVES RODRIGUEZ D.O.

Provider Business Mailing Address
First Line	:	30 CALLE WASHINGTON
Second Line	:	SUITE 5
City	:	SAN JUAN
State	:	PR
Zip	:	00907-1589
Country	:	US
Telephone Number	:	787-722-0215
Fax Number	:	787-723-8783

Provider Business Practice Location Address
First Line	:	30 CALLE WASHINGTON
Second Line	:	SUITE 5
City	:	SAN JUAN
State	:	PR
Zip	:	00907-1589
Country	:	US
Telephone Number	:	787-722-0215
Fax Number	:	787-723-8783

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

Provider Enumeration Date	:	12/21/2006
Last Update Date	:	07/08/2007

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