Provider Demographics
NPI:1083163596
Name:DR ENRIQUE RODRIGUEZ DECLET LLC
Entity Type:Organization
Organization Name:DR ENRIQUE RODRIGUEZ DECLET LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:ENRIQUE
Authorized Official - Middle Name:
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:1787-626-5272
Mailing Address - Street 1:PO BOX 6059
Mailing Address - Street 2:
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00726-6059
Mailing Address - Country:US
Mailing Address - Phone:178-762-6527
Mailing Address - Fax:787-258-2545
Practice Address - Street 1:C2 CALLE JOSE VILLARES
Practice Address - Street 2:URB PARADIS
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725
Practice Address - Country:US
Practice Address - Phone:178-762-6527
Practice Address - Fax:787-258-2545
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-26
Last Update Date:2016-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR792171100000X
PR6248207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Single Specialty
No171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty