Provider Demographics
NPI:1457563041
Name:RODRIGUEZ, RUBEN (LO)
Entity Type:Individual
Prefix:MR
First Name:RUBEN
Middle Name:
Last Name:RODRIGUEZ
Suffix:
Gender:M
Credentials:LO
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 570
Mailing Address - Street 2:
Mailing Address - City:MAYAGUEZ
Mailing Address - State:PR
Mailing Address - Zip Code:00681-0570
Mailing Address - Country:US
Mailing Address - Phone:787-833-3137
Mailing Address - Fax:787-833-3137
Practice Address - Street 1:AVE. CORAZONES
Practice Address - Street 2:SUITE 1020
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00680
Practice Address - Country:US
Practice Address - Phone:787-833-3137
Practice Address - Fax:787-833-3137
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR188156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician