1124135785 NPI number — ANGEL D. NAZARIO-RODRIGUEZ M.D.

Table of content: ANGEL D. NAZARIO-RODRIGUEZ M.D. (NPI 1124135785)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124135785 NPI number — ANGEL D. NAZARIO-RODRIGUEZ M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NAZARIO-RODRIGUEZ
Provider First Name:
ANGEL
Provider Middle Name:
D.
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1124135785
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/13/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1775
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CIDRA
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00739-1775
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-738-9938
Provider Business Mailing Address Fax Number:
787-738-9939

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
CARR 14 INTERIOR KM 0.3
Provider Second Line Business Practice Location Address:
CENTRO MEDICO MENONITA EDIFICIO PROFESIONAL SUITE 311
Provider Business Practice Location Address City Name:
CAYEY
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00736
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-738-9938
Provider Business Practice Location Address Fax Number:
787-738-9939
Provider Enumeration Date:
08/23/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207V00000X , with the licence number:  14850 , registered in the state of PR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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