1699141093 NPI number — SJL OFICINA MEDICA DRA MELISSA RODRIGUEZ CSP

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699141093 NPI number — SJL OFICINA MEDICA DRA MELISSA RODRIGUEZ CSP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SJL OFICINA MEDICA DRA MELISSA RODRIGUEZ CSP
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:
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:
1699141093
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/19/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
149 HACIENDA PRIMAVERA
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
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-678-9798
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
77 BETANCES ESQUINA MUNOZ RIVERA
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CAGUAS
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00725
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-743-4077
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/19/2015

Additional Information

Authorized Official

Authorized Official Last Name:
RODRIGUEZ-MORENO
Authorized Official First Name:
MELISSA
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
787-678-9798

Provider Taxonomy Codes

  • Taxonomy code: 261QP2300X , with the licence number:  17861 , 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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