1851470942 NPI number — MR. MIGUEL ANGEL RODRIGUEZ BSPH

Table of content: TREVOR OWENS COTA/L (NPI 1225560261)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1851470942 NPI number — MR. MIGUEL ANGEL RODRIGUEZ BSPH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RODRIGUEZ
Provider First Name:
MIGUEL
Provider Middle Name:
ANGEL
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
BSPH
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
RODRIGUEZ
Provider Other First Name:
MIGUEL
Provider Other Middle Name:
ANGEL
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
BSPH
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1851470942
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
211 AVE JOSE DE DIEGO
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ARECIBO
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00612-4547
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-717-1255
Provider Business Mailing Address Fax Number:
305-847-3831

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
211 AVE.JOSE DE DIEGO
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ARECIBO
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00614
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-879-5284
Provider Business Practice Location Address Fax Number:
305-847-3831
Provider Enumeration Date:
11/02/2006

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: 183500000X , with the licence number:  3118 , 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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