Provider Demographics
NPI:1093353633
Name:RODRIGUEZ, CARLOS
Entity Type:Individual
Prefix:
First Name:CARLOS
Middle Name:
Last Name:RODRIGUEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 37126
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00937-0126
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:PROGRAMA SIDA DE SAN JUAN
Practice Address - Street 2:AVE FERNANDEZ JUNCOS 1306
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00908
Practice Address - Country:US
Practice Address - Phone:787-480-3000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-13
Last Update Date:2020-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR76664163WG0600X
PR17677163WC1500X, 163WP2201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP2201XNursing Service ProvidersRegistered NurseAmbulatory Care
No163WG0600XNursing Service ProvidersRegistered NurseGerontology
No163WC1500XNursing Service ProvidersRegistered NurseCommunity Health