Provider Demographics
NPI:1477239705
Name:RODRIGUEZ AMBERT, CARLOS IVAN
Entity Type:Individual
Prefix:
First Name:CARLOS
Middle Name:IVAN
Last Name:RODRIGUEZ AMBERT
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:M32 CALLE 17A
Mailing Address - Street 2:
Mailing Address - City:ARECIBO
Mailing Address - State:PR
Mailing Address - Zip Code:00612-2552
Mailing Address - Country:US
Mailing Address - Phone:939-240-3160
Mailing Address - Fax:
Practice Address - Street 1:M32 CALLE 17A
Practice Address - Street 2:
Practice Address - City:ARECIBO
Practice Address - State:PR
Practice Address - Zip Code:00612-2552
Practice Address - Country:US
Practice Address - Phone:939-240-3160
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-22
Last Update Date:2023-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program