Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207PP0204X | Pediatric Emergency Physician | 288283 | NY |
NPI | 1740629922 |
---|---|
Provider Name | Dr. Eddie Gabriel Rodriguez |
First Address | San Juan, PR 00909-5001 |
Second Address | Ponce, PR 00716-4717 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/06/2013 |
Last Update Date | 30/03/2020 |