Provider Demographics
NPI:1114001799
Name:LEONARDO RODRIGUEZ
Entity Type:Organization
Organization Name:LEONARDO RODRIGUEZ
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:LEONARDO
Authorized Official - Middle Name:
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:1787-612-2206
Mailing Address - Street 1:210 CALLE HIJA DEL CARIBE
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00918-3245
Mailing Address - Country:US
Mailing Address - Phone:787-612-2206
Mailing Address - Fax:
Practice Address - Street 1:CARRETERA 698 NUM 400.BO MAMEYAL.
Practice Address - Street 2:
Practice Address - City:DORADO
Practice Address - State:PR
Practice Address - Zip Code:00646
Practice Address - Country:US
Practice Address - Phone:787-278-3331
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR14820282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital