Provider Demographics
NPI:1407978414
Name:RODRIGUEZ SOSA, ELMO (MD)
Entity Type:Individual
Prefix:
First Name:ELMO
Middle Name:
Last Name:RODRIGUEZ SOSA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:166 CALLE NIZA
Mailing Address - Street 2:EXT.EL COMANDANTE
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00982-3610
Mailing Address - Country:US
Mailing Address - Phone:787-757-6022
Mailing Address - Fax:
Practice Address - Street 1:102 CALLE PEDRO ARZUAGA E
Practice Address - Street 2:
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00985-6132
Practice Address - Country:US
Practice Address - Phone:787-257-3963
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-03
Last Update Date:2011-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR8240202C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes202C00000XAllopathic & Osteopathic PhysiciansIndependent Medical Examiner
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR29431Medicare ID - Type Unspecified
PRE81608Medicare UPIN