Provider Demographics
NPI:1205660826
Name:RODRIGUEZ SUAREZ, CRISTOPHER
Entity type:Individual
Prefix:
First Name:CRISTOPHER
Middle Name:
Last Name:RODRIGUEZ SUAREZ
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 1:320 VIA LA MANSION
Mailing Address - Street 2:URB MANSIONES DEL LAGO
Mailing Address - City:TOA BAJA
Mailing Address - State:PR
Mailing Address - Zip Code:00949-3265
Mailing Address - Country:US
Mailing Address - Phone:787-447-1718
Mailing Address - Fax:
Practice Address - Street 1:2020 AVE BORINQUEN
Practice Address - Street 2:
Practice Address - City:SANJUAN
Practice Address - State:PR
Practice Address - Zip Code:00915-3822
Practice Address - Country:US
Practice Address - Phone:787-268-4171
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-27
Last Update Date:2024-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1027174H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator