Provider Demographics
NPI:1497513691
Name:RODRIGUEZ, EDIEL ANDRES
Entity Type:Individual
Prefix:
First Name:EDIEL
Middle Name:ANDRES
Last Name: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 1:1357 AVE ASHFORD
Mailing Address - Street 2:STE 2 PMB 203
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00907
Mailing Address - Country:US
Mailing Address - Phone:787-404-7397
Mailing Address - Fax:
Practice Address - Street 1:20 CALLE WASHINGTON
Practice Address - Street 2:APT 6C
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00907
Practice Address - Country:US
Practice Address - Phone:787-404-7397
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-12
Last Update Date:2024-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program