Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208D00000X | General Practice Physician | 22445 | PR |
NPI | 1013682533 |
---|---|
Provider Name | Dr. Hector Rodriguez Diaz |
First Address | Bayamon, PR 00959-2136 |
Second Address | Corozal, PR 00783 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/08/2021 |
Last Update Date | 16/08/2021 |