Provider Demographics
NPI:1295949865
Name:RODRIGUEZ SANTIAGO, EDUARDO (1562B)
Entity type:Individual
Prefix:
First Name:EDUARDO
Middle Name:
Last Name:RODRIGUEZ SANTIAGO
Suffix:
Gender:M
Credentials:1562B
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 1292
Mailing Address - Street 2:
Mailing Address - City:CABO ROJO
Mailing Address - State:PR
Mailing Address - Zip Code:00623-1292
Mailing Address - Country:US
Mailing Address - Phone:787-231-5758
Mailing Address - Fax:
Practice Address - Street 1:PARRA MEDICAL PLAZA AVE PONCE BY PASS
Practice Address - Street 2:SUITE 904-905
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00717
Practice Address - Country:US
Practice Address - Phone:787-844-2710
Practice Address - Fax:787-844-2832
Is Sole Proprietor?:No
Enumeration Date:2007-05-10
Last Update Date:2020-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1562B146N00000X
PR079-PA363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, Basic