1164600847 NPI number — FIDEL J RODRIGUEZ CRUZ

Table of content: (NPI 1164600847)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164600847 NPI number — FIDEL J RODRIGUEZ CRUZ

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FIDEL J RODRIGUEZ CRUZ
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
BEST VISION CANOVANAS
Provider Other Organization Name Type Code:
3
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:
1164600847
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/14/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1270
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CANOVANAS
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00729-1270
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-256-6060
Provider Business Mailing Address Fax Number:
787-256-6061

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
CARRETERA # 3 KM 19.9
Provider Second Line Business Practice Location Address:
EDIFICIO EAST MEDICAL PROFESSIONAL CENTER
Provider Business Practice Location Address City Name:
CANOVANAS
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00729
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-256-6060
Provider Business Practice Location Address Fax Number:
787-256-6061
Provider Enumeration Date:
02/05/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
RODRIGUEZ
Authorized Official First Name:
FIDEL
Authorized Official Middle Name:
JOEL
Authorized Official Title or Position:
OPTICIAN
Authorized Official Telephone Number:
787-256-6060

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 156FX1800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208D00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332H00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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