Provider Demographics
NPI:1275957862
Name:DR. EDWIN F. RODRIGUEZ ALLENDE,CSP
Entity Type:Organization
Organization Name:DR. EDWIN F. RODRIGUEZ ALLENDE,CSP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWIN
Authorized Official - Middle Name:F
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-462-7559
Mailing Address - Street 1:PO BOX 1450
Mailing Address - Street 2:
Mailing Address - City:AIBONITO
Mailing Address - State:PR
Mailing Address - Zip Code:00705-1450
Mailing Address - Country:US
Mailing Address - Phone:787-735-1830
Mailing Address - Fax:787-735-1890
Practice Address - Street 1:202 CALLE JULIO CINTRON
Practice Address - Street 2:EDIFICIO GUAYACAN, OF. 107
Practice Address - City:AIBONITO
Practice Address - State:PR
Practice Address - Zip Code:00705-1450
Practice Address - Country:US
Practice Address - Phone:787-735-1830
Practice Address - Fax:787-735-1890
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-18
Last Update Date:2014-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR11105207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRF77133Medicare UPIN