Provider Demographics
NPI:1619394202
Name:RODRIGUEZ, RAMON
Entity Type:Individual
Prefix:MR
First Name:RAMON
Middle Name:
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:PO BOX 179
Mailing Address - Street 2:
Mailing Address - City:SAINT JUST
Mailing Address - State:PR
Mailing Address - Zip Code:00978-0179
Mailing Address - Country:US
Mailing Address - Phone:787-360-6549
Mailing Address - Fax:787-755-0083
Practice Address - Street 1:207 CALLE DE DIEGO
Practice Address - Street 2:
Practice Address - City:RIO PIEDRAS
Practice Address - State:PR
Practice Address - Zip Code:00925-3201
Practice Address - Country:US
Practice Address - Phone:787-360-6549
Practice Address - Fax:787-755-0083
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-21
Last Update Date:2014-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR910122172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver