Provider Demographics
NPI:1033396924
Name:RODRIGUEZ, RAHUEL ISAI (LICOPTICIAN)
Entity Type:Individual
Prefix:MR
First Name:RAHUEL
Middle Name:ISAI
Last Name:RODRIGUEZ
Suffix:
Gender:M
Credentials:LICOPTICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:COND.EL MILENIO # 300 220ST
Mailing Address - Street 2:APTDO 1006
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00982
Mailing Address - Country:US
Mailing Address - Phone:787-762-5669
Mailing Address - Fax:787-762-5669
Practice Address - Street 1:URB.VALLE ARRIBA HEIGHT BA-20
Practice Address - Street 2:LOCAL # 3
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00984
Practice Address - Country:US
Practice Address - Phone:787-762-5669
Practice Address - Fax:787-762-5669
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-23
Last Update Date:2008-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR656156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician