Provider Demographics
NPI:1316376874
Name:BURGOS- RODRIGUEZ, MAICKOL (NS)
Entity Type:Individual
Prefix:
First Name:MAICKOL
Middle Name:
Last Name:BURGOS- RODRIGUEZ
Suffix:
Gender:M
Credentials:NS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC 4 BOX 17804
Mailing Address - Street 2:
Mailing Address - City:CAMUY
Mailing Address - State:PR
Mailing Address - Zip Code:00627-9502
Mailing Address - Country:US
Mailing Address - Phone:787-237-6430
Mailing Address - Fax:
Practice Address - Street 1:HC 4 BOX 17804
Practice Address - Street 2:
Practice Address - City:CAMUY
Practice Address - State:PR
Practice Address - Zip Code:00627-9502
Practice Address - Country:US
Practice Address - Phone:787-237-6430
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-11-05
Last Update Date:2013-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR35735G164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse