Provider Demographics
NPI:1659044915
Name:CARUCO, RODRIGO MANUEL
Entity Type:Individual
Prefix:
First Name:RODRIGO
Middle Name:MANUEL
Last Name:CARUCO
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 1:525 N FAYETTE ST UNIT 321
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22314-2270
Mailing Address - Country:US
Mailing Address - Phone:301-747-3181
Mailing Address - Fax:
Practice Address - Street 1:808 JANNEYS LN
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22302-3918
Practice Address - Country:US
Practice Address - Phone:301-747-3181
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-31
Last Update Date:2021-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator