Provider Demographics
NPI:1275315814
Name:NAZARIO RODRIGUEZ, EMANUEL ANDRES
Entity Type:Individual
Prefix:
First Name:EMANUEL
Middle Name:ANDRES
Last Name:NAZARIO 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:HC 3 BOX 35104
Mailing Address - Street 2:
Mailing Address - City:MOROVIS
Mailing Address - State:PR
Mailing Address - Zip Code:00687-9087
Mailing Address - Country:US
Mailing Address - Phone:787-664-0264
Mailing Address - Fax:
Practice Address - Street 1:997 CALLE SAN ROBERTO
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00926-2759
Practice Address - Country:US
Practice Address - Phone:787-773-6508
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-18
Last Update Date:2023-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program