1114001799 NPI number — LEONARDO RODRIGUEZ

Table of content: (NPI 1114001799)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114001799 NPI number — LEONARDO RODRIGUEZ

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LEONARDO RODRIGUEZ
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:
1114001799
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
210 CALLE HIJA DEL CARIBE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN JUAN
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00918-3245
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-612-2206
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
CARRETERA 698 NUM 400.BO MAMEYAL.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DORADO
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00646
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-278-3331
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/24/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
RODRIGUEZ
Authorized Official First Name:
LEONARDO
Authorized Official Middle Name:
Authorized Official Title or Position:
GENERAL PRACTITIONER
Authorized Official Telephone Number:
17876122206

Provider Taxonomy Codes

  • Taxonomy code: 282N00000X , with the licence number:  14820 , 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)