1306439666 NPI number — DR. JAYSHA LEE INFANTE RODRIGUEZ PHARMD

Table of content: DR. JAYSHA LEE INFANTE RODRIGUEZ PHARMD (NPI 1306439666)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306439666 NPI number — DR. JAYSHA LEE INFANTE RODRIGUEZ PHARMD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
INFANTE RODRIGUEZ
Provider First Name:
JAYSHA
Provider Middle Name:
LEE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PHARMD
Provider Gender Code:
F

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:
1306439666
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/18/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
CALLE BOHEMIA 1163
Provider Second Line Business Mailing Address:
URB. PUERTO NUEVO
Provider Business Mailing Address City Name:
SAN JUAN
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00920
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-340-2404
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
WALGREENS #222 LOS COLOBOS
Provider Second Line Business Practice Location Address:
150 CARRETERA 857
Provider Business Practice Location Address City Name:
CAROLINA
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00987
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-701-0808
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/18/2021

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:  6868 , 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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